Homograft Aortic Root Replacement for Destructive Prosthetic Valve Endocarditis: Results in the Current Era

被引:0
|
作者
Pocar, Marco [1 ,2 ,3 ]
Barbero, Cristina [1 ,2 ]
Marro, Matteo [1 ,2 ]
Ferrante, Luisa [1 ,2 ]
Costamagna, Andrea [2 ,4 ]
Fazio, Luigina [5 ]
La Torre, Michele [1 ,2 ]
Boffini, Massimo [1 ,2 ]
Salizzoni, Stefano [1 ,2 ]
Rinaldi, Mauro [1 ,2 ]
机构
[1] Div Cardiac Surg & Cardiothorac Transplantat, Citta Salute & Sci, I-10126 Turin, Italy
[2] Univ Turin, Dept Surg Sci, I-10126 Turin, Italy
[3] Univ Milan, Dept Clin Sci & Community Hlth, I-20122 Milan, Italy
[4] Dept Anaesthesia Intens Care & Emergency, Cardiac Intens Care Unit, Citta Salute & Sci, I-10126 Turin, Italy
[5] Tissue Bank, Citta Salute & Sci, I-10126 Turin, Italy
关键词
infective endocarditis; aortic root replacement; reoperation; prosthetic valve; homograft; sepsis; organ dysfunction; INFECTIVE ENDOCARDITIS; CLINICAL PROFILE; RISK; EXPERIENCE; SURVIVAL; SEPSIS;
D O I
10.3390/jcm13154532
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. Methods: A retrospective analysis was conducted on 61 consecutive patients who underwent a cardiac reoperation comprising homograft aortic root replacement since 2010. The probabilities of survival were calculated with the Kaplan-Meier method, whereas multivariable regression served to outline the predictors of adverse events. The endpoints were operative/late death, perioperative low cardiac output and renal failure, and reoperations. Results: The operative (cumulative hospital and 30-day) mortality was 13%. The baseline aspartate transaminase (AST) and associated mitral procedures were predictive of operative death (p = 0.048, OR [95% CIs] = 1.03 [1-1.06]) and perioperative low cardiac output, respectively (p = 0.04, OR [95% CIs] = 21.3 [2.7-168.9] for valve replacement). The latter occurred in 12 (20%) patients, despite a normal ejection fraction. Survival estimates (+/- SE) at 3 months, 6 months, 1 year, and 3 years after surgery were 86.3 +/- 4.7%, 82.0 +/- 4.9%, 75.2 +/- 5.6, and 70.0 +/- 6.3%, respectively. Survival was significantly lower in the case of AST >= 40 IU/L (p = 0.04) and aortic cross-clamp time >= 180 min (p = 0.01), but not when excluding operative survivors. Five patients required early (two out of the five, within 3 months) or late (three out of the five) reoperation. Conclusions: Homograft aortic root replacement for destructive prosthetic valve endocarditis can currently be performed with a near 90% operative survival and reasonable 3-year mortality and reoperation rate. AST might serve to additionally stratify the operative risk.
引用
收藏
页数:11
相关论文
共 50 条
  • [41] Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era
    Saha, Shekhar
    Ali, Ahmad
    Schnackenburg, Philipp
    Horke, Konstanze Maria
    Oberbach, Andreas
    Schlichting, Nadine
    Sadoni, Sebastian
    Rizas, Konstantinos
    Braun, Daniel
    Luehr, Maximilian
    Bagaev, Erik
    Hagl, Christian
    Joskowiak, Dominik
    JOURNAL OF CLINICAL MEDICINE, 2022, 11 (12)
  • [42] Surgical Options for Aortic Root Replacement in Destructive Endocarditis
    Szczechowicz, Marcin
    Weymann, Alexander
    Mkalaluh, Sabreen
    Mashhour, Ahmed
    Zhigalov, Konstantin
    BRAZILIAN JOURNAL OF CARDIOVASCULAR SURGERY, 2020, 35 (03) : 265 - 273
  • [43] Aortic Root Replacement for Destructive Endocarditis - Clinic and Microbiology
    Szczechowicz, Marcin P.
    Weymann, Alexander
    Mkalaluh, Sabreen
    Mashhour, Ahmed
    Zhigalov, Konstantin
    Sa, Michel Pompeu B. O.
    Zubarevich, Alina
    Easo, Jerry
    BRAZILIAN JOURNAL OF CARDIOVASCULAR SURGERY, 2021, 36 (05) : 614 - 622
  • [44] Allograft aortic root replacement in complex prosthetic endocarditis
    Lopes, Sergio
    Calvinho, Paulo
    de Oliveira, Ferrao
    Antunes, Manuel
    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2007, 32 (01) : 126 - 130
  • [45] Advantage of autograft and homograft valve replacement for complex aortic valve endocarditis - Discussion
    Oswalt, JD
    Knott-Craig
    ANNALS OF THORACIC SURGERY, 1999, 67 (06): : 1608 - 1608
  • [46] Aortic Homograft for Treatment of Aortic Root Endocarditis With Concomitant Mitral Valve Destruction
    Northrup, William F., III
    ANNALS OF THORACIC SURGERY, 2010, 90 (04): : 1395 - 1396
  • [47] Mycotic aortic root aneurysm following Candida endocarditis in an aortic valve homograft
    Sticherling, C
    Schacherer, C
    Brodt, HR
    INTERNIST, 1999, 40 (10): : 1089 - 1092
  • [48] Homograft valve repair for recurrent prosthetic valve endocarditis
    Lee, R
    Moon, MR
    JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2003, 125 (03): : 725 - 727
  • [49] HOMOGRAFT AND PROSTHETIC AORTIC-VALVE REPLACEMENT - COMPARATIVE-STUDY
    PINE, M
    HAHN, G
    PATON, B
    PAPPAS, G
    DAVIES, H
    STEELE, P
    PRYOR, R
    BLOUNT, SG
    CIRCULATION, 1976, 54 (06) : 84 - 89
  • [50] Prosthetic Valve Endocarditis After Transcatheter and Surgical Aortic Valve Replacement
    Fukuhara, Shinichi
    Wu, Xiaoting
    Hawkins, Robert
    Ailawadi, Gorav
    Deeb, Michael
    ANNALS OF THORACIC SURGERY, 2023, 116 (02): : 314 - 321