Acute aortic endocarditis with annular destruction: Assessment of surgicaltreatment with cryopreserved valvular homografts

Background and aim of the study: Valve ring abscesses in acute infective ao rtic endocarditis have a low, though not insignificant, prevalence. Surgica l treatment with implantation of prosthetic valves may lead to major life-t hreatening complications, such as recurrent endocarditis and partial or com plete prosthetic dislocation. Valvular homografts may offer a higher resist ance to recurrent infection and have thus become recognized as an excellent and safe substitute for orthotopic left ventricular outflow reconstruction . Methods: Between May 1991 and July 1996, 25 patients underwent surgical t reatment for aortic endocarditis with annular destruction. Staphylococcus s pp. were present in 32% of patients and Streptococcus spp. in 48%. Seven ao rtic valve replacements (AVR) and 18 aortic root replacements (ARR) were pe rformed using cryopreserved valvular homografts. All grafts were implanted in the subannular position. Results: The overall outcome was good in 23 pat ients, two died in the early postoperative period. Mean follow up was 38 +/ - 18 months (range: 14 to 76 months). No recurrence of endocarditis was det ected and no significant alterations of the implants were described. Transv alvular gradients were significantly lower in ARR patients than in AVR pati ents. Conclusions: Despite the severity of the tissue damage, cryopreserved homog rafts, when implanted in the subannular position, constitute a safe and rep roducible surgical treatment of aortic endocarditis with annular involvemen t.