SURGICAL-TREATMENT OF ACUTE ENDOCARDITIS OF THE AORTIC-VALVE WITH PARAVALVULAR ABSCESS - CONSIDERATIONS JUSTIFYING THE USE OF MECHANICAL REPLACEMENT DEVICES

Objective. Early recurrency after surgery for acute endocarditis is a life-threatening complication. Allograft valves are supposed to have a higher resistance to recur rent infection, thus several authors claim them to be the replacement device of choice in cases of aortic endoca rditis. However, allografts have two major drawbacks: their availabili ty is limited, and most of the patients require reoperation for graft calcification of degeneration. Until now there has been no prospective study analysing whether early recurrency after surgery of acute endoc arditis is associated with the mechanical valve per se or with factors related to the surgical technique or postoperative care. Patients and methods. We present a prospective study on 36 consecutive patients wi th acute endocarditis of the aortic valve with paravalvular abscesses. In this series, there were 5 women and 31 men with a mean age of 50.3 years. All patients were operated before a course of antibiotic thera py was completed. Abscesses were radically resected and the cavities c losed either with direct suture or, if not possible, with Dacron patch es. For aortic valve replacement, a mechanical valve was used in every patient. Results. The early mortality in this series was 14%, only on e patient experienced recurrent endocarditis and underwent reoperation , The results compare well with those achieved after valve replacement s with allograft valves. Conclusion. We conclude that, even in cases o f acute endocarditis, replacement of the aortic valve with a mechanica l device is an acceptable alternative to the allograft, if radical sur gical debridement and adequate antibiotic therapy are performed.