PMID- 7955252
OWN - NLM
STAT- MEDLINE
DCOM- 19941209
LR  - 20041117
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 90
IP  - 5 Pt 2
DP  - 1994 Nov
TI  - Evaluation of unstented aortic homografts for the treatment of prosthetic aortic 
      valve endocarditis.
PG  - II198-204
AB  - BACKGROUND: Prosthetic aortic valve endocarditis is a serious complication that 
      carries a high morbidity and mortality. Aortic homografts have been used in this 
      setting, but long-term results are not available. METHODS AND RESULTS: Over a 
      23-year period, 48 patients presented with infected aortic valve substitutes: 28 
      homografts, 15 mechanical, and 5 xenografts. Nineteen patients had emergency 
      surgery, and the mean interval between the first and second operation was 5.9 
      years (range, 1 month to 22 years). In 28 patients, the preoperative New York 
      Heart Association (NYHA) class was III or IV. Active endocarditis was present in 
      39 patients, and the microorganisms grown were Staphylococcus epidermidis (n = 
      13), Staphylococcus aureus (n = 6), Streptococcus viridans (n = 6), Streptococcus 
      faecalis (n = 4), Candida albicans (n = 5), and Gram-negative spp (n = 2). Aortic 
      root abscesses were found in 28 (58%) patients, and transesophageal 
      echocardiography was 95% accurate in their localization. All patients received 
      homograft aortic valves, 19 as root replacement and 29 using the freehand 
      technique. There were four (8.3%) early deaths; poor left ventricular function 
      and concomitant procedure were identified as risk factors. At a mean follow-up of 
      4 years (range, 2 months to 19 years) 95% of the patients were in NYHA class I or 
      II without significant aortic regurgitation. The actuarial survival at 5 years 
      was 97% (confidence limit, 84% to 100%), and freedom from endocarditis at 10 
      years was 97% (confidence limit, 84% to 100%). Multivariate analysis did not 
      identify risk factors for these late events. CONCLUSIONS: Homograft aortic valves 
      offer good early and long-term results in patients with infected aortic valve 
      substitutes.
FAU - Petrou, M
AU  - Petrou M
AD  - Harefield Hospital, London, UK.
FAU - Wong, K
AU  - Wong K
FAU - Albertucci, M
AU  - Albertucci M
FAU - Brecker, S J
AU  - Brecker SJ
FAU - Yacoub, M H
AU  - Yacoub MH
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Actuarial Analysis
MH  - Aortic Valve/*transplantation
MH  - Endocarditis/epidemiology/microbiology/*surgery
MH  - Endocarditis, Bacterial/epidemiology/microbiology/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Prosthesis/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Postoperative Complications/epidemiology
MH  - Prosthesis-Related Infections/epidemiology/microbiology/*surgery
MH  - Reoperation
MH  - Risk Factors
MH  - Survival Analysis
MH  - Time Factors
EDAT- 1994/11/01 00:00
MHDA- 1994/11/01 00:01
CRDT- 1994/11/01 00:00
PHST- 1994/11/01 00:00 [pubmed]
PHST- 1994/11/01 00:01 [medline]
PHST- 1994/11/01 00:00 [entrez]
PST - ppublish
SO  - Circulation. 1994 Nov;90(5 Pt 2):II198-204.