Advantage of autograft and homograft valve replacement for complex aortic valve endocarditis

Background. There are advantages to using homografts and autografts as aort ic valve replacements, particularly in patients with infective endocarditis . To better define these advantages, we reviewed our 13-year experience wit h the surgical management of infective endocarditis involving the aortic va lve and root. Methods. From 1986 through 1998, 81 adults with aortic valve endocarditis u nderwent valve replacement (AVR). The mean age of the 65 men and 16 women w as 44 +/- 14 years. Sixty-three (78%) patients had active endocarditis at t he time of operation. Non-native valve endocarditis was present in 29 (36%) patients, in 9 of whom the infection was a recurrence. Aortic valve replac ements were performed with 46 homografts (homo-AVR), 25 autografts (Ross-AV R), and 10 prosthetic valves (prosth-AVR). Among Ross-AVR and homo-AVR pati ents, 11 required mitral valve replacement or repair (homo-Ross DVR). Follo w-up was 90% complete within 2 years of the end of the study with a mean of 3.7 +/- 3.4 years. Results. Early mortality was 16% (13 of 81 patients). This was 12% (3 of 25 patients) for Ross-AVR, 17% (8 of 46 patients) for homo-AVR, and 20% (2 of 10 patients) for prosth-AVR. Overall late mortality was 10% (7 of 68 patie nts) with a valve-related late mortality of 7% (5 of 68 patients). Actuaria l survival at 5 years was 88% +/- 9% in Ross-AVR, 69% +/- 11% in homo-AVR, and 29% +/- 22% in prosth-AVR (p = 0.03). Endocarditis recurred in 12.5% (1 of 8 patients) with prosth-AVR and 3% (2 of 60 patients) in homo-Ross AVR. Conclusions. Valve replacement in the presence of native and prosthetic end ocarditis remains a formidable challenge. Autografts and homografts are the preferred replacement aortic valves for these patients even if concomitant mitral valve replacement is required, and risk of valve-related death or r ecurrent endocarditis is low at medium-term follow-up. (C) 1999 by The Soci ety of Thoracic Surgeons.