Prosthetic valve sewing-ring sealing with antibiotic and fibrin glue in infective endocarditis. A prospective clinical study.
To analyze the benefits of prosthetic valve sewing ring sealing with antibiotic and fibrin glue in endocarditis, a prospective study was undertaken in 16 consecutive patients. Valvular lesions concerned aortic valve in seven patients, mitral valve in three and both in six. Preoperative antibiotic treatment was started 15+/-15 days before surgery. Peroperative findings showed six isolated valvular lesions and ten perivalvular extensions. Before the prostheses were sutured to the annulus, the Dacron sewing rings were covered with antibiotic and fibrin glue. The antibiotic was chosen according to the micro-organism identified preoperatively. We didn't have any peroperative mortality or paravalvular leakage (PVL). One patient died suddenly on postoperative day (POD) nine (non-contributive autopsy). Another patient was reoperated on POD 31 for PVL. Peroperative local bacteriological examinations were sterile. Mean follow-up was of 9.3+/-6.8 months and was completed in all cases. Actuarial survival rate was 94+/-6% and freedom from reoperation was 92+/-7%. Antibiotic treatment was stopped after 59+/-64 days for 10 patients. None of them had recurrence of endocarditis or PVL. Prosthetic valve sewing ring sealing with adapted antibiotic and fibrin glue can constitute a good weapon in the armamentarium of surgical treatment of active endocarditis.
Department of Cardiovascular Surgery B, Claude Bernard University, INSERM E226, Louis Pradel Hospital, Bron Cedex, France. fadi.farhat@chu-lyon.fr
Fadi
F
Farhat
Marion
M
Durand
François
F
Delahaye
Olivier
O
Jegaden
D000890:Anti-Infective Agents / Q000008:administration & dosage*; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000601:surgery*; D015996:Survival Rate; D013536:Suture Techniques; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D015718:Fibrin Tissue Adhesive