title: Early and mid-term results of the Shelhigh stentless bioprosthesis in patients with active infective endocarditis.
abstract: OBJECTIVE
  This study investigated the early and mid-term results following valve replacement with the new Shelhigh stentless bioprosthesis made entirely of biological material in patients with active infective endocarditis (AIE).
  
  
  METHODS
  Between 02/2000 and 12/2004, 164 patients (n = 122 men, mean age 59, 18-85 years) received implantation of an AIE Shelhigh stentless bioprosthesis in the aortic, mitral, tricuspid or pulmonary position. A total of 119 patients (72.6%) had native AIE and 45 (27.4%) prosthetic AIE. A large proportion of the patients reached the operating room in a condition of cardiac decompensation: 37 (22.6%) patients were intubated, 40 (24.4%) had protracted septic shock and 41 (25.0%) required intensive catecholamine treatment. Surgery was regarded as urgent in 94 patients (57.4%) and was performed as an emergency procedure in 70 (42.6%). The mean follow-up time is 1.5 +/- 0.11 years (range, 5 months to 5.2 years). Echocardiographic follow-up examinations were performed early postoperatively and after 12 months.
  
  
  RESULTS
  In terms of the operative indication, we found a highly significant difference in the survival rate between patients who were operated on urgently vs in an emergency. In patients who died within 30 days, the main cause of death was septic multiorgan failure (67.6%). Only three patients required reoperation due to reinfection of the Shelhigh bioprostheses; this represents a reinfection rate of 1.8% in relation to the whole cohort. The postoperative echocardiographic examinations showed the Shelhigh valves to have very good hemodynamics without relevant pressure gradients.
  
  
  CONCLUSIONS
  Our experience in the use of Shelhigh bioprostheses in patients with native and prosthetic endocarditis show the early and mid-term results, in particular the low reinfection rate and the good hemodynamics, to be comparable with the results achieved using homografts. Since these prostheses are readily available and their implantation straightforward, they are increasingly being used in patients with endocarditis. These promising results need to verified in the long term.
authors.affiliation: Deutsches Herzzentrum Berlin, Abt. für Herz-, Thorax und Gefässchirurgie, Augustenburger Platz 1, 13353, Berlin, Germany. musci@dhzb.de
authors.forename: Michele
authors.initials: M
authors.lastname: Musci
authors.forename: H
authors.initials: H
authors.lastname: Siniawski
authors.forename: C
authors.initials: C
authors.lastname: Knosalla
authors.forename: O
authors.initials: O
authors.lastname: Grauhan
authors.forename: Y
authors.initials: Y
authors.lastname: Weng
authors.forename: M
authors.initials: M
authors.lastname: Pasic
authors.forename: R
authors.initials: R
authors.lastname: Meyer
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014463:Ultrasonography