Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement
Open accessAbstract
The outcome of 30 consecutive patients with active aortic prosthetic valve endocarditis and root abscesses treated by the technique of homograft aortic root replacement with reimplantation of the coronary arteries is detailed. The principles of this technique are the removal of all abscesses and infected areas likely to drain into the infected mediastinum, excision of infected tissues down to healthy noninfected tissue and replacement with an antibiotic-impregnated homograft aortic root. All patients had evidence of progressive cardiac failure and ongoing sepsis. Mean patient age (+/- SD) at the time of operation was 42 +/- 18 years. The mean number of previous aortic valve replacements per patient was 1.6 +/- 0.7; 14 patients (47%) had undergone greater than or equal to 2 previous replacements. At operation, aortic root abscesses were found in all patients; abscess extension to adjacent structures and partial valve dehiscence had occurred in 23. In-hospital death occurred in 9 (30%) of the 30 patients. The 21 hospital survivors have been followed up for a mean of 66 +/- 42 months (range 9 to 144). Overall, 17 (81%) of the 21 hospital survivors have remained free of major adverse events (recurrence of endocarditis, need for reoperation or death). The results of our study suggest that homograft aortic root replacement should be considered favorably in the treatment of patients with aortic prosthetic valve endocarditis and root abscesses.
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Under conditions of extensive destruction of periannular supporting tissues, human aortic homografts, when available, can be used to replace the damaged aortic valve and to reconstruct the damaged aorta.
“Under these conditions, human aortic homografts, when available, can be used to replace the damaged aortic valve and to reconstruct the damaged aorta.310,311”
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- Authors
- Glazier, J. J., Verwilghen, J., Donaldson, R. M., & Ross, D. N.
- Affiliations
- University College Hospital at Westmoreland Street (GB)
- Corresponding author
- Glazier, James J.
- ORCID
- Glazier, James J.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1991-04
- Volume
- 17
- Issue
- 5
- Pages
- 1177-1182
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2071620212
- Cited by
- 144
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 3 · 2020: 1 · 2019: 2 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 5 · 2014: 3 · 2013: 4 · 2012: 4
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Infectious Aortic and Vascular Conditions
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Keywords
- prosthetic valve endocarditis, aortic valve endocarditis, annular abscess, coronary artery reimplantation, valve dehiscence, recurrent endocarditis, heart failure, sepsis, reoperation
- MeSH terms
- Abscess, Adolescent, Adult, Aged, Aorta, Aortic Valve, Child, Coronary Vessels, Endocarditis, Female, Follow-Up Studies, Haemophilus Infections, Heart Valve Prosthesis, Humans, Male, Middle Aged, Reoperation, Retrospective Studies, Staphylococcal Infections, Transplantation, Homologous, Survival Rate
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