Long-term outcome of cryopreserved allograft for aortic valve replacement

Abstract

Cryopreserved allograft is a valid option, especially in complex infective endocarditis and in women of childbearing age. A careful choice of allograft size and implantation technique can reduce the risk of SVD.

Aortic homografts: Unrealized expectations and hard reoperations at the end

“…This increased rate of reoperation in the second decade after implantation is consistently and predictably observed in all the published series, 8 as it is in this current report of Nappi and colleagues. 2 Similarly, in this current report of Nappi and colleagues, 2 freedom from reoperation decreased from 84% at 15 years to 15% at 20 years. These rates of reoperation are hard to differentiate from the reported rates of reoperation of biologic valves and are clearly higher than the rates for mechanical valves.…”

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

“…Asymptomatic patients with small lesions with no or mild aortic regurgitation should be observed until the development of symptoms or aortomitral regurgitation and considered for elective surgical correction of AVE. 9 Most studies, however, show a sizable proportion (25%-60%) of IE patients presenting with complex lesions and periannular abscess formation. [2][3][4]9,20,21,65 The goal of the multidisciplinary team is to provide the best possible treatment for patients requiring difficult medical and surgical management. The involvement of the perfusionist may be essential especially in cases of extracorporeal circulation prior to surgery.…”

“…Evidence from observational studies, however, strongly suggest that surgical intervention is valuable. 3,4,9,10 One such study evaluated the impact of early surgery on long-term outcomes in 304 consecutive adult patients who active IE involving the aortic valve, Aortic Homografts ( 20 The patients who received an Ao-H had a higher incidence of prosthetic valve endocarditis (58.1% vs 28.8%, P = .002) and methicillin-resistant Staphylococcus infection (25.6% vs 12.1%, P = .002), compared to those who surgical correction was performed using conventional prostheses. After propensity-score analyses to adjust baseline characteristics, the choice of a homograft did not significantly affect early death (odds ratio 1.61; 95% confidence interval [CI], 0.73-3.40, P = .23), overall death (hazard ratio 1.10; 95% CI, 0.62-1.94, P = .75), or reinfection (hazard ratio 1.04; 95% CI, 0.49-2.18, P = .93).…”

“…1,2 Although infectious injury of one or more leaflets is the most common complication of native AVE, the extension of pathogens to other contiguous structures close to the aortic valve (AV) such as the aortic root, left ventricular outflow tract down to the mitral valve, called infectious aortopathy, is also present in approximately 64% of affected persons. 3,4 Evidence to date suggests that the pattern of infectious disease in patients with aortic valve involvement is diverse, possibly reflecting the heterogeneity in age, sex, pathogens implicated, prosthetic valve endocarditis (PVE), alongside clinical and surgical features. 1,2,[5][6][7] Surgical treatment of aortic valve endocarditis today is generally performed using conventional mechanical and stented xenograft prosthesis or cryopreserved aortic homograft while aortic valve repair is limited to well-circumscribed infectious injuries.…”

“…1,2,[5][6][7] Surgical treatment of aortic valve endocarditis today is generally performed using conventional mechanical and stented xenograft prosthesis or cryopreserved aortic homograft while aortic valve repair is limited to well-circumscribed infectious injuries. 3,4,[8][9][10] However, the literature does not provide sufficient data for a systematic approach to AVE operations due to the lack of randomized trials classified as Class Ia level A or B, which may guide the timing and choices of the ideal substitute for infectious aortic valve disease. [8][9][10][11][12][13] We performed an analysis of several reports in which different surgical strategies were compared for the treatment of aortic valve endocarditis and its complications to overcome limitations of individual observational studies in detecting differences in clinical outcomes, beginning with our own experience of valve surgery.…”