PMID- 9030790
OWN - NLM
STAT- MEDLINE
DCOM- 19970507
LR  - 20190512
IS  - 1010-7940 (Print)
IS  - 1010-7940 (Linking)
VI  - 11
IP  - 1
DP  - 1997 Jan
TI  - Emergency surgery for acute infective aortic valve endocarditis: performance of 
      cryopreserved homografts and mode of failure.
PG  - 53-61
AB  - OBJECTIVE: To describe our experience in the surgical treatment of infective, 
      native and prosthetic aortic valve endocarditis, using cryopreserved homograft 
      valves. METHODS: Between January 1988 and September 1995, cryopreserved 
      homografts were implanted in 49 patients (mean age 47 +/- 15 years; range 19-79) 
      with acute infective endocarditis of the native (21/49; 43%) or the prosthetic 
      (28/49; 57%) aortic valve. Aortic root abscesses were found in 39/49 (80%) 
      patients, ventriculo-aortic disconnection in 27/49 (55%). An intracardiac 
      fistula, originating from the left ventricular outflow tract was found in 25/49 
      (51%) patients. Indications for emergency surgery were congestive heart failure 
      due to severe aortic valve regurgitation in 44/49 (90%) and systemic emboli in 
      5/49 (10%) patients. Preoperatively, 23/49 (47%) patients were in New York Heart 
      Association (NYHA) class IV, and 5/49 (10%) were in acute circulatory failure. 
      Mean left ventricular ejection fraction was 53 +/- 10% (25-65). Streptococci 
      (27%) and staphylococci (27%) were the most important microorganisms found. The 
      homograft was implanted as a scalloped freehand valve (34/49; 70%), as an 
      intra-aortic inclusion cylinder (4/49; 6%) or as a free-standing root replacement 
      (12/49; 24%). Combined procedures were necessary in 11/49 (22.5%) patients. 
      RESULTS: Hospital mortality was 8.2% (4/49): 2/49 (4.1%) patients died from 
      endocarditis-related sepsis, one (2%) from low cardiac output and one (2%) from a 
      cerebrovascular accident. After a mean interval of 21 +/- 15 months (2-48), 9/45 
      (20%) patients had to be reoperated, all reoperations except one being homograft 
      related. After a mean follow-up of 35 +/- 22 months (2-90), 4/44 (9%) patients 
      had their homograft replaced by a mechanical prosthesis. After 5 years, actuarial 
      freedom from late death was 97 +/- 3%; from late reoperation 69 +/- 9%; from late 
      endocarditis 85 +/- 8%; and from late homograft degeneration 87 +/- 6%. Explanted 
      homografts were acellular and non-vital, containing bacteria and/or leucocytes. 
      B-lymphocytes were found in all and in one, T-cell lymphocytes were present. 
      CONCLUSION: Emergency aortic valve replacement with cryopreserved homografts for 
      acute native or prosthetic aortic valve endocarditis has a low operative 
      mortality. The late incidence of recurrent endocarditis or homograft failure up 
      to 7 years is acceptable. Cryopreserved homografts are non-viable. The presence 
      of T-cell lymphocytes in explanted homografts indicates that rejection may be 
      possible.
FAU - Vogt, P R
AU  - Vogt PR
AD  - Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
FAU - von Segesser, L K
AU  - von Segesser LK
FAU - Jenni, R
AU  - Jenni R
FAU - Niederhauser, U
AU  - Niederhauser U
FAU - Genoni, M
AU  - Genoni M
FAU - Kunzli, A
AU  - Kunzli A
FAU - Schneider, J
AU  - Schneider J
FAU - Turina, M I
AU  - Turina MI
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Actuarial Analysis
MH  - Acute Disease
MH  - Adult
MH  - Aged
MH  - Aortic Valve Insufficiency/mortality/physiopathology/*surgery
MH  - *Bioprosthesis
MH  - Cryopreservation
MH  - *Emergencies
MH  - Endocarditis, Bacterial/mortality/physiopathology/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis
MH  - Hemodynamics/physiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications/*etiology/mortality/surgery
MH  - Prosthesis Failure
MH  - Reoperation
MH  - Staphylococcal Infections/mortality/physiopathology/*surgery
MH  - Streptococcal Infections/mortality/physiopathology/*surgery
MH  - Survival Rate
MH  - Transplantation, Homologous
EDAT- 1997/01/01 00:00
MHDA- 1997/01/01 00:01
CRDT- 1997/01/01 00:00
PHST- 1997/01/01 00:00 [pubmed]
PHST- 1997/01/01 00:01 [medline]
PHST- 1997/01/01 00:00 [entrez]
AID - S1010794096010639 [pii]
AID - 10.1016/s1010-7940(96)01063-9 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 1997 Jan;11(1):53-61. doi: 
      10.1016/s1010-7940(96)01063-9.