Advantage of autograft and homograft valve replacement for complex aortic valve endocarditis
| Autor: | Ronald C. Elkins, Mary M. Lane, Krishnaswamy Chandrasekaran, Kazuo Niwaya, Christopher J. Knott-Craig, Kathylee Santangelo |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic valve Adult Male medicine.medical_specialty Prosthesis-Related Infections Heart disease medicine.medical_treatment Heart Valve Diseases Prosthesis Transplantation Autologous Valve replacement Internal medicine medicine Endocarditis Humans Transplantation Homologous Aged Retrospective Studies business.industry Mitral valve replacement Endocarditis Bacterial Middle Aged medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Infective endocarditis Concomitant Aortic Valve Heart Valve Prosthesis Cardiology Female Cardiology and Cardiovascular Medicine business Echocardiography Transesophageal |
| Zdroj: | The Annals of thoracic surgery. 67(6) |
| ISSN: | 0003-4975 |
| Popis: | Background . There are advantages to using homografts and autografts as aortic valve replacements, particularly in patients with infective endocarditis. To better define these advantages, we reviewed our 13-year experience with the surgical management of infective endocarditis involving the aortic valve and root. Methods . From 1986 through 1998, 81 adults with aortic valve endocarditis underwent valve replacement (AVR). The mean age of the 65 men and 16 women was 44 ± 14 years. Sixty-three (78%) patients had active endocarditis at the time of operation. Non-native valve endocarditis was present in 29 (36%) patients, in 9 of whom the infection was a recurrence. Aortic valve replacements were performed with 46 homografts (homo-AVR), 25 autografts (Ross-AVR), and 10 prosthetic valves (prosth-AVR). Among Ross-AVR and homo-AVR patients, 11 required mitral valve replacement or repair (homo-Ross DVR). Follow-up was 90% complete within 2 years of the end of the study with a mean of 3.7 ± 3.4 years. Results . Early mortality was 16% (13 of 81 patients). This was 12% (3 of 25 patients) for Ross-AVR, 17% (8 of 46 patients) for homo-AVR, and 20% (2 of 10 patients) for prosth-AVR. Overall late mortality was 10% (7 of 68 patients) with a valve-related late mortality of 7% (5 of 68 patients). Actuarial survival at 5 years was 88% ± 9% in Ross-AVR, 69% ± 11% in homo-AVR, and 29% ± 22% in prosth-AVR ( p = 0.03). Endocarditis recurred in 12.5% (1 of 8 patients) with prosth-AVR and 3% (2 of 60 patients) in homo-Ross AVR. Conclusions . Valve replacement in the presence of native and prosthetic endocarditis remains a formidable challenge. Autografts and homografts are the preferred replacement aortic valves for these patients even if concomitant mitral valve replacement is required, and risk of valve-related death or recurrent endocarditis is low at medium-term follow-up. |
| Databáze: | OpenAIRE |
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