EVALUATION OF UNSTENTED AORTIC HOMOGRAFTS FOR THE TREATMENT OF PROSTHETIC AORTIC-VALVE ENDOCARDITIS

Background Prosthetic aortic valve endocarditis is a serious complicat ion that carries a high morbidity and mortality. Aortic homografts hav e been used in this setting, but longterm results are not available. M ethods and Results Over a 23-year period, 48 patients presented with i nfected aortic valve substitutes: 28 homografts, 15 mechanical, and 5 xenografts. Nineteen patients had emergency surgery, and the mean inte rval between the first and second operation was 5.9 years (range, 1 mo nth to 22 years). In 28 patients, the preoperative New York Heart Asso ciation (NYHA) class was III or N. Active endocarditis was present in 39 patients, and the microorganisms grown were Staphylococcus epidermi dis (n=13), Staphylococcus aureus (n=6), Streptococcus viridans (n=6), Streptococcus faecalis (n=4), Candida albicans (n=5), and Gram-negati ve spp (n=2). Aortic root abscesses were found in 28 (58%) patients, a nd transesophageal echocardiography was 95% accurate in their localiza tion. All patients received homograft aortic valves, 19 as root replac ement and 29 using the freehand technique. There were four (8.3%) earl y deaths; poor left ventricular function and concomitant procedure wer e identified as risk factors. At a mean follow-up of 4 years (range, 2 months to 19 years) 95% of the patients were in NYHA class I or II wi thout significant aortic regurgitation. The actuarial survival at 5 ye ars was 97% (confidence limit, 84% to 100%), and freedom from endocard itis at 10 years was 97% (confidence limit, 84% to 100%). Multivariate analysis did not identify risk factors for these late events. Conclus ions Homograft aortic valves offer good early and long-term results in patients with infected aortic valve substitutes.