Document Detail


Replacing the ascending aorta and aortic valve for acute prosthetic valve endocarditis: is using prosthetic material contraindicated?
MedLine Citation:
PMID:  12440665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The use of prosthetic material (rather than a homograft) for ascending aorta/aortic valve replacement (Bentall procedure) in cases of acute prosthetic valve endocarditis is controversial. We report favorable results using this technique almost exclusively (a homograft was used in only 3 patients with hematological problems) during a 12-year interval. METHODS: Twenty-eight patients (55 +/- 14 years; 22 male) underwent a Bentall procedure for acute prosthetic valve endocarditis between 1988 and 2000. Twenty-five patients had undergone previous aortic valve replacement (1 with concomitant mitral valve replacement, 4 with coronary artery bypass grafting), and 3 had had a previous Bentall operation. The median interval between initial surgery and reoperation was 13 months (range, 1 to 106). Sixty-eight percent of operations were urgent or emergencies. Ninety-three percent of patients had significant aortic regurgitation; complete annuloaortic dehiscence occurred in 71%, and in 57%, an abscess was found. Causative organisms were identified in 25 of 28 patients: Staphylococcus epidermidis (9), Staphylococcus aureus (7), Streptococcus viridans (6), Pseudomonas (2), and Legionella (1). RESULTS: Twenty-three patients had mechanical and 5 had biological valves implanted during the Bentall procedure. Hypothermic circulatory arrest was used in 64%. Hospital mortality was 11%: there was one intraoperative death, and two before discharge (one cardiac, one sepsis). Eighty-nine percent survived without stroke. During follow-up (median, 44.5 months; complete in 92%), 1 patient died of recurrent endocarditis at 4 months. CONCLUSIONS: These results indicate that prosthetic root replacement may be superior to use of a homograft for acute aortic prosthetic valve endocarditis, with only a 4% incidence of recurrent endocarditis and reoperation.
Authors:
Christian Hagl; Jan D Galla; Steven L Lansman; Daniel Fink; Carol A Bodian; David Spielvogel; Randall B Griepp
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  74     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-20     Completed Date:  2002-12-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S1781-5; discussion S1792-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York, USA. chagl@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aorta / transplantation*
Aortic Valve / transplantation*
Bioprosthesis / contraindications
Blood Vessel Prosthesis / contraindications*
Cause of Death
Endocarditis, Bacterial / mortality,  surgery*
Female
Follow-Up Studies
Heart Valve Prosthesis / contraindications*
Hospital Mortality
Humans
Male
Middle Aged
Prosthesis-Related Infections / mortality,  surgery*
Reoperation / methods,  mortality
Survival Rate
Transplantation, Homologous

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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