Aortic allograft infection risk

ESC guidelines 2023 on the management of endocarditis

“…In experienced centres, the use of allografts has been preferred as they have the advantage of adapting to irregular surfaces and provide haemostatic advantages with very good haemodynamic function and low thrombo-embolic risk, and can be used to repair concomitant lesions of the anterior mitral valve leaflet. 557,558 Additionally, allografts and stentless bioprostheses can be beneficial in small aortic roots and are associated with low reinfection rates. However, experience is generally limited to single-centre case series and there is no clear evidence of superiority of one valve substitute over the other.…”

The Use of the Cryopreserved Aortic Homograft for Aortic Valve Replacement: Is It Still an Option?

“…The use of cryopreserved allograft for aortic valve and aortic root replacement has been shown to be a valid alternative in selected patients with aortic native or prosthetic valve endocarditis [ 1 , 2 , 6 , 8 ]. Unfortunately, the advantage inherent to the optimal hemodynamic performance and the avoidance of life-long anticoagulation is counterbalanced by the known tendency of these conduits to deteriorate, requiring reoperation normally associated with a high morbidity and early mortality of 8–17.9% [ 9 ].…”

“…In this context, the implantation technique plays a fundamental role in strongly influencing the amount of tissue in contact with the host and therefore the susceptibility to immune reactions [ 6 , 7 , 8 , 20 , 21 , 22 , 23 ] and the geometry of the root complex after the replacement [ 4 ]. The miniroot technique is thought to preserve the aortic root geometry, minimizing aortic regurgitation [ 7 , 8 , 20 , 26 ] with greater durability than the subcoronary approach [ 1 , 2 , 4 , 8 , 27 ]. However, we suggest removing the excess tissue from the homograft to avoid geometrical obstruction and unnecessary tissue contact with the host [ 8 , 17 , 22 , 23 , 25 ].…”

“…However, considering the relatively short time range in which the operations have been performed, we can reliably speculate that these confounding variables would not have played a role in the results of the study. A time-based analysis was performed by Fukushima et al in their series of 840 patients, with a timeframe of analysis significantly wider than in our cohort (from 1975 till 2008) [ 1 ], in which drastic changes in healthcare occurred. Another limit consists of the presence of censored cases in the survival analysis that might have underpowered the statistical significance of the analysis.…”

“…The consideration of cryopreserved aortic homograft (CAH) valve substitutes has been advocated as an acceptable alternative to conventional aortic valve replacement in selected patients [ 1 , 2 ]). Since their introduction by Sir Donald Ross in 1962, cryopreserved homografts have been widely used in the past in light of their advantages, inherent optimal hemodynamic performance, low thrombogenicity, avoidance of life-long anticoagulation, low rate of neurological events, and low risk of infection.…”