ALLOGRAFT AORTIC ROOT REPLACEMENT IN PROSTHETIC AORTIC-VALVE ENDOCARDITIS - A REVIEW OF 32 PATIENTS

Background. This study was conducted to evaluate allograft aortic root replacement in the setting of complicated prosthetic valve endocardit is with extensive annular destruction. Methods. From January 1990 thro ugh March 1996, 32 patients diagnosed with complicated prosthetic valv e endocarditis underwent allograft root replacement. Mean age was 58.3 +/- 13.2 years; 23 patients were men. Mean preoperative New York Hear t Association functional class was 3.4. Staphylococcus epidermidis (50 %) and Enterococcus faecalis (19%) were the predominant causative micr oorganisms. Annular abscesses were found in 26 patients (81%), aortic- mitral discontinuity in 14 patients (43%), and left ventricular-aortic discontinuity in 11 patients (34%). A cryopreserved allograft was use d in 31 patients (97%) and a fresh antibiotic-treated allograft was us ed in 1 patient (3%). Mean aortic cross-clamp time was 150 +/- 29 minu tes. Mean duration of the postoperative antibiotic treatment was 38.5 +/- 11.8 days. Results. There were three operative deaths (9.4%); caus es of death were multiorgan failure in 2 patients (6.2%) and low cardi ac output in 1 patient (3.2%). Six patients (18%) had complete heart b lock (4 patients already before the operation), 3 patients (9.4%) had temporary respiratory insufficiency, and 1 patient (3.2%) needed tempo rary hemodialysis. Mean follow-up was 37.4 +/- 22.4 months. Two late d eaths occurred: 1 patient had recurrent endocarditis, leading to a fal se aneurysm, and died at reoperation; another patient died of lung can cer. Actuarial 5-year survival was 87.3% (70% confidence interval, 76. 8% to 97.8%); actuarial 5-year freedom from recurrent endocarditis was 96.5% (70% confidence interval, 90.0% to 100%). Conclusions. Allograf t aortic root replacement is a valuable technique in the complex setti ng of prosthetic valve endocarditis with involvement of the periannula r region. Mortality and morbidity are low. (C) 1997 by The Society of Thoracic Surgeons.