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Title: Surgical treatment of endocarditis with an aortic homograft

Mariusz Kuśmierczyk, Jacek Różański, Krzysztof Kotliński, Hanna Siudalska, Katarzyna Barańska, Piotr Hoffman, Andrzej Biederman
Original articles
Polish Journal of Cardiology
Start page:
Final page:
aortic homograft, aortic valve disease, endocarditis, aortic valve replacement

Introduction: Endocarditis is still a relevant disease. An aortic valve replacement with mechanical prosthesis is a most common surgical treatment. In some patients the disease spreads into the valve annulus or periannullar abscess can develop. In such cases an optimal treatment method seems to be implantation of an aortic homograft (AH) which is composed only of biological tissues and does not contain any artificial materials. Aim of study: The aim of the study was to asses the early and long-term results surgical treatment aortic valve endocarditis with using aortic homograft implantation inourclinic. Material and methods: From 1991 to 2005, in the I Department of Cardiosurgery, Instituteof Cardiology, Warsaw, Poland, a total number of 37 patients (8 women and 29 men) ranging in age from 15 to 66 years (mean age 37 years), under went AH implantation due to aortic valve endocarditis. The indications for using AH were established due to endocarditis of aortic annulus orperiannular abscess. In primary operation AH was implanted in 20 patients, 17 patients had pervious cardiac surgery. In one case due to renal failure patient required to have hemodializes performed before operation. In two patients with congenital heart defects pulmonary homografts were inserted in right outflow ventricular tract additionally. In all the patients implantation technique was "root replacement". Results: Perioperative mortality was 5.4% (due to multiorgan failure). There were two late deaths (5.4%) related to aortic valve endocarditis of mycotic etiology. The reoperation was necessary in 2 cases: in 1 patient due to homograft dissection and in another one due to reinfection and homograft valve insufficiency. The group of 31 patients stays in longtime observation ranged from 2 months to 15 years (average follow up of 68 months). Symptomatic improvement insurvivors was excellent. According to clinical criteria, all the followed up patients were in NYHA functional class I. Echocardiography demonstrated homografts with no degenerations ignsor significant transvalvular gradients, trivial to mild aortic regurgitation is observed. Conclusions 1. Aortic homograft implantation due to endocarditis can be performed with low perioperative risk. 2. Homograft AVR is safe and produces good early and longterm results with low mortality. 3. The AH implantation is excellent therapeutic option especially for active aortic valve endocarditis involving aortic ring.