Homograft and Autograft in the Treatment of Active Aortic Valve Endocarditis: Early and Midterm Results

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Abstract

Background

Aortic valve homograft and pulmonary autograft replacement of the aortic valve in patients with active infective endocarditis are attractive alternatives. The aim of this study was to evaluate the early and mid-term results of this surgery in our institution.

Material and method

Between June1992 and March 1999, 30 patients with diagnosis of active infective endocarditis of the aortic valve without positive response to treatment underwent aortic replacement with aortic homograft or pulmonary autograft. Mean age of patients was 48 ± 16 years; 24 patients (80%) were male. Surgical success of homograft or autograft valve implantation was monitored with trans-esophageal echo.

Results

Twenty patients had native aortic valve endocarditis and 10 patients aortic prosthetic valve endocarditis. Blood cultures was positive in 25 patients (83.3%). Causative organisms were Streptoccus viridans 10, Staphylococcus aureus 9, Gram-negative bacteria 3, and other microorganisms 4. Rational basis for surgery were: heart failure 18 patients, annular abscess 7, sepsis 3 and uncontrolled fever 2. Homografts were implanted in 27 patients and the Ross procedure was performed in 3subjects. In 15 patients aortic valve replacement was combined with other procedures. In-hospital mortality was 16.5% (5 patients). Survival at follow-up (44 months) was 92% (CI71-100%). Free-dom from endocarditis was 92% (CI 71-100%).

Conclusion Aortic homograft or pulmonary autograft may be safely applied in patients with active aortic valve endocarditis with acceptable in-hospital mortality and low rates of thromboembolism and infection.