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Allograft aortic root surgery. The infected aortic root

  • Conference paper
Cardiac Valve Allografts

Abstract

The major early anatomical complication of native aortic valve endocarditis is valve regurgitation (or jet lesion) and the onset of ventricular failure followed by aortic ring and burrowing root abscesses during treatment at which the indication for operative intervention becomes very necessary and urgent. Prosthetic valve endocarditis is more insidious in the onset and with an organism of high virulence like Staphylococcus epidermidis, the clinical course is likely to be complicated by suture dehiscence resulting in paravalvular leakage and burrowing root abscesses, myocarditis and onset of ventricular failure. In a prospective study in 1991, the incidence of postoperative infection of prosthetic valve substitutes in a sterile aortic root was found to be 0.9% (12/1393 cases) as compared to 14.4% (16/111 cases) in infected roots (15). Surgical management simply designed to replace the infected native valve or prosthesis including local debridement is likely to fail due to the persistence of residual infected tissue retained within the blood circulation (3, 8, 15). Since 1988, we have adopted the technique of surgical exclusion of infected aortic root tissue from the blood circulation by homograft aortic valve and root replacement instead of using synthetic material (2).

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References

  1. Albertucci M, Wong K, Petrou M, Mitchell A, Somerville J, Theodoropoulos S, Yacoub M (1994) The use of unstented homograft valves for aortic valve reoperations. Review of a twenty-three-year experience. J Thorac Cardiovasc Surg 107: 152–161

    PubMed  CAS  Google Scholar 

  2. Bentall HH, DeBono A (1968) A technique for complete replacement of the ascending aorta. Thorax 23: 338–339

    Article  PubMed  CAS  Google Scholar 

  3. Donaldson RM, Ross DN (1984) Homograft aortic root replacement for complicated prosthetic valve endocarditis. Circulation 70(Suppl 1): I179–I182

    Google Scholar 

  4. Matsuki O, Robles A, Gibbs S, Bodnar E, Ross DN (1988) Long-term performance of 555 aortic homografts in the aortic position. Ann Thorac Surg 46: 187–191

    Article  PubMed  CAS  Google Scholar 

  5. O’Brien MF, Finney RS, Stafford EG, Gardner MAH, Pohlner PG, Tesar PJ, Cochrane AD, Gall KL, Smith SE (1995) Root replacement for all allograft aortic valves: preferred technique or too radical? Ann Thorac Surg 60: S87–S91

    Article  PubMed  Google Scholar 

  6. Okita Y, Franciosi G, Matsuki O, Robbies A, Ross DN (1988) Early and late results of aortic root replacement with antibiotic-sterilized aortic homograft. J Thorac Cardiovasc Surg 95: 696–704

    PubMed  CAS  Google Scholar 

  7. Petrou M, Wong K, Albertucci M, Brecker SJ, Yacoub MH (1994) Evaluation of unstented aortic homografts for the treatment of prosthetic aortic valve endocarditis. Circulation 90(Suppl 2): II198–I1204

    PubMed  CAS  Google Scholar 

  8. Ross DN (1988) Aortic root replacement with a cardiac allograft. The infected root. In: Cardiac valve allografts 1962–1987. (AC Yankah, R Hetzer, DC Miller, DN Ross, J Somerville, MH Yacoub, eds.). Steinkopff Verlag, Darmstadt, Springer Verlag, New York, pp 167–171

    Google Scholar 

  9. Somerville J, Ross DN (1982) Homograft replacement of aortic root with reimplantation of coronary arteries. Br Heart J 47: 473–482

    Article  PubMed  CAS  Google Scholar 

  10. Yacoub MH (1988) Allograft aortic root replacement. In: Cardiac valve allografts 1962–1987. (AC Yankah, R Hetzer, DC Miller, DN Ross, J Somerville, MH Yacoub, eds.). Steinkopff Verlag, Darmstadt, Springer Verlag, New York, pp 149–55

    Google Scholar 

  11. Yacoub M, Rasmi NRH, Sundt TM, Lund O, Boyland E, Radley-Smith R, Khaghani A, Mitchell A (1995) Fourteen-year experience with homovital homografts for aortic valve replacement. J Thorac Cardiovasc Surg 110: 186–194

    Article  PubMed  CAS  Google Scholar 

  12. Yankah AC, Sievers HH, Bürsch JH, Radtke W, Lange P, Heintzen PH, Bernhard A (1984) Orthotopic transplantation of aortic valve allografts. Early hemodynamic results, Thorac Cardiovasc Surgeon 32: 92–95

    Article  CAS  Google Scholar 

  13. Yankah AC, Wottge HU, Müller-Hermelink HK, Feller AC, Lange P, Wessel U, Dreyer H, Bernhard A, Müller-Ruchholtz W (1987) Transplantation of aortic and pulmonary allografts, enhanced viability of endothelial cells by cryopreservation, importance of histocompatibility. J Cardiac Surg 2(Suppl): 209–220

    CAS  Google Scholar 

  14. Yankah AC, Hetzer R (1989) Valve selection and choice in surgery of endocarditis. J Cardiac Surg 4: 324–330

    Article  CAS  Google Scholar 

  15. Yankah AC, Weng Y, Schiessler A, Waraecke H, Fleck E, Hetzer R (1991) Comparison of mechanical vs. bioprosthetic vs. allograft valve substitute for infective aortic root. Proceedings 5th annual meeting European Assoc. for Cardiothoracic Surgery, Abstr. Nr. 65, p 16

    Google Scholar 

  16. Yankah AC, Siniawski H, Lange PE, Fleck E, Hetzer R (1995) Connaissances de Base. Allogreffes et autogreffes valvulaires cardiaques. Conservation et chirurgie (D. Metras ed.) Masson, Paris, Milan, Barcelone, pp 49-78

    Google Scholar 

  17. Yankah AC, Weng Y, Hofmeister J, Alexi-Meskhishvili V, Siniawski H, Lange PE, Hetzer R (1996) Freehand subcoronary aortic valve and aortic root replacement with cryo-preserved homografts: Intermediate term results. J. Heart Valve Dis. 5: 498–504

    PubMed  CAS  Google Scholar 

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© 1997 Springer-Verlag Berlin Heidelberg

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Yankah, A.C., Weng, Y., Hofmeister, J., Siniawski, H., Hetzer, R. (1997). Allograft aortic root surgery. The infected aortic root. In: Yacoub, M.H., Yankah, A.C., Hetzer, R. (eds) Cardiac Valve Allografts. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-642-59250-8_22

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  • DOI: https://doi.org/10.1007/978-3-642-59250-8_22

  • Publisher Name: Steinkopff, Heidelberg

  • Print ISBN: 978-3-642-63915-9

  • Online ISBN: 978-3-642-59250-8

  • eBook Packages: Springer Book Archive

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