Graft Selection for Aortic Root Replacement in Complex Active Endocarditis: Does It Matter?

• Published in: The Annals of thoracic surgery Vol. 93; no. 2; pp. 480 - 487
• Main Authors: Jassar, Arminder Singh, MBBS, Bavaria, Joseph E., MD, Szeto, Wilson Y., MD, Moeller, Patrick J., BS, Maniaci, Jon, Milewski, Rita K., MD, PhD, Gorman, Joseph H., MD, Desai, Nimesh D., MD, PhD, Gorman, Robert C., MD, Pochettino, Alberto, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2012; Elsevier
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aneurysm, False - epidemiology; Aneurysm, False - surgery; Aorta - surgery; Aortic Aneurysm - epidemiology; Aortic Aneurysm - surgery; Aortic Rupture - epidemiology; Aortic Rupture - surgery; Aortic Valve - abnormalities; Aortic Valve - surgery; Biological and medical sciences; Bioprosthesis - statistics & numerical data; Blood Vessel Prosthesis - classification; Blood Vessel Prosthesis - statistics & numerical data; Blood Vessel Prosthesis Implantation - statistics & numerical data; Cardiology. Vascular system; Cardiothoracic Surgery; Debridement; Endocardial and cardiac valvular diseases; Endocarditis, Bacterial - surgery; Female; Heart; Heart Valve Prosthesis; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Pneumology; Polyethylene Terephthalates; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Reoperation - statistics & numerical data; Retrospective Studies; Sternotomy - statistics & numerical data; Surgery; 26; Root; Selection; Cardiovascular disease; Replacement; Complexes; Treatment; Heart disease; Surgery; Endocardial disease; Endocarditis; Anesthesia; Aorta; Graft; Circulatory system; Cardiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.09.074

Background Endocarditis affecting the aortic valve, with abscess formation and root destruction, remains a challenge to treat. Aortic root homografts have been advocated because of a perceived lower risk of infective complications than with other root replacement grafts. However, the theoretical advantage of homografts has not been re-evaluated in the modern era. This report is based on an examination of our results for all aortic root replacements in complex, active endocarditis affecting the aortic valve. Methods From 2000 to 2010, 134 patients (70.9% male; mean age 58.3 ± 14.8 years) at our institution underwent aortic root replacement for active endocarditis. Ninety of the patients (67.2%) had a previously implanted prosthetic aortic valve. Our findings for these patients included one or more of the following: abscess (n = 110, 82.1%), valve vegetation (n = 98, 73.1%), and pseudoaneurysm or rupture or both (n = 62, 46.3%). We retrospectively reviewed data for the patients from hospital records and the social security data base. Results A mechanical composite graft (MC) was used in 43 of the patients (32.1%), a non-homograft biologic valve conduit (BC) in 55 patients (41.0%), and a homograft (HG) valve in 36 patients (26.9%). There was no significant difference among the groups in the incidence of major complications or in-hospital mortality. During a mean follow-up of 32.1 ± 29.4 months, the rates of readmission, reinfection, and reoperation were similar for the three groups. The mean 5-year survival in the study was 58 ± 9% for the MC group, 62 ± 7% for the BC group, and 58 ± 9% for the HG group, respectively ( p = 0.48). Conclusions Aortic root replacement in the presence of complex active infection is associated with significant morbidity and mortality. We report that the rates of major complications and late mortality were similar among MC, BC, and HG groups in our study.