Allograft aortic root surgery. The infected aortic root
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).
KeywordsGall Staphylococcus Endocarditis Myocarditis Metras
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