| Surgical management of acute aortic root endocarditis with viable homograft: 13-year experience. | |
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MedLine Citation:
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PMID: 11825733 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Cryopreserved homograft valves have been used for acute infective aortic root endocarditis with great success but it is compounded by its availability in all sizes. The long-term clinical results of geometric mismatched homografts are not well defined and addressed. METHODS: Over a 15-year period (April 1986-June 2001), 816 patients presented with active infective endocarditis. One hundred and eighty-two of the patients aged between 9 and 78 years (mean: 51.0 +/- 1.13 years) consisting of 142 males and 40 females received homograft aortic valves. One hundred and ten patients were in NYHA functional class III and 72 in class IV and in cardiogenic shock. Of the patients, 2.7% suffered from septic embolism. One hundred and twenty-four (68.1%) patients presented with periannular abscesses and 58 (31.9%) with no abscess while 107 native valve (NVE) and 75 prosthetic valve (PVE) endocarditis were diagnosed preoperatively by transesophageal echocardiography (TEE) and confirmed intraoperatively. Freehand subcoronary implantation (FSCI) was used in 106 patients and root replacement in 76 patients. RESULTS: The operative death was 8.5% and for patients in NYHA functional class IV and in cardiogenic shock was 14.5%. Late mortality rate was 7.9%. Patient survival after discharge from hospital at 1 year was 97% and at 10 years was 91%, respectively. Thirty-one (22.1%) patients underwent reoperation after 1.7 years (mean) with two deaths (6.4%). Early (< or = 60 days) and late reinfection rate was 2.7 and 3.6%, respectively. Freedom from reoperation for matched and undersized homografts at 10-13 years was 85 and 55%, respectively. The univariate model identified undersized homograft (P=0.002), FSCI (P=0.09) and reinfection (P=0.0001) as independent risk factors for developing early and late valve dysfunction resulting in reoperation and homograft explant. CONCLUSION: Early aggressive valve replacement with homograft for active infective aortic root endocarditis with periannular abscesses is more successful than delayed last resort surgery. Homografts exhibit excellent clinical performance and durability with a low rate of reinfection, if properly inserted. Undersized homograft is an incremental risk factor for early and late reoperation. |
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Authors:
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A C Yankah; H Klose; R Petzina; M Musci; H Siniawski; R Hetzer |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 21 ISSN: 1010-7940 ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 2002 Feb |
Date Detail:
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Created Date: 2002-02-04 Completed Date: 2002-03-27 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: England |
Other Details:
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Languages: eng Pagination: 260-7 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic and Vascular Surgery, Humboldt University Berlin, Deutsches Herzzentrum Berlin, Augustenburger Platz 1 D-13353 Berlin, Germany. yankah@dhzb.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Analysis of Variance Aortic Valve / microbiology*, surgery* Child Cohort Studies Cryopreservation Echocardiography, Doppler Endocarditis, Bacterial / mortality, surgery*, ultrasonography Female Follow-Up Studies Graft Rejection Graft Survival Heart Valve Diseases / microbiology, surgery* Humans Male Middle Aged Organ Transplantation / methods*, mortality Postoperative Complications / epidemiology Probability Retrospective Studies Risk Assessment Survival Rate Transplantation, Homologous Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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