Performance and Durability of Cryopreserved Allograft Aortic Valve Replacements

Witten, James C.; Durbak, Emily; Houghtaling, Penny L.; Unai, Shinya; Roselli, Eric E.; Bakaeen, Faisal G.; Johnston, Douglas R.; Svensson, Lars G.; Jaber, Wael A.; Blackstone, Eugene H.; Pettersson, Gösta

doi:10.1016/j.athoracsur.2020.07.033

Cited by 10 publications

(17 citation statements)

References 27 publications

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“…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.…”

Section: Surgical Approach and Techniquesmentioning

confidence: 99%

ESC guidelines 2023 on the management of endocarditis

de Waha,

Desch,

Tilz

et al. 2023

Herz

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Section: Surgical Approach and Techniquesmentioning

confidence: 99%

ESC guidelines 2023 on the management of endocarditis

de Waha,

Desch,

Tilz

et al. 2023

Herz

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“…While surgical replacement of the infected valvular tissue remains the primary treatment [19], the surgical community has been debating the best option for an aortic substitute, whether it should be a conventional xenograft or mechanical prosthesis, or allogenic or autologous tissues for decades. Several variables, such as the patient's age, risk factors, comorbidities, and contraindications to anticoagulation, as well as anatomopathological factors such as the extent of the infection and pathogen virulence, the timing of intervention, and specific features of the aortic substitute used such as durability and risk of infection recurrence, require prompt assessment during the decision-making process for surgical treatment of IE [40][41][42][43][44][45][46][47][48][49][50][51].…”

Section: Resultsmentioning

confidence: 99%

A Literature Review on the Use of Aortic Allografts in Modern Cardiac Surgery for the Treatment of Infective Endocarditis: Is There Clear Evidence or Is It Merely a Perception?

Nappi,

Schoell,

Spadaccio

et al. 2023

Life

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Infective valve endocarditis is caused by different pathogens and 60% of those involve the aortic valve with valve failure. Although S. aureus is recognized as the most frequently isolated causative bacterium associated with IE in high-income countries, Gram-positive cocci nevertheless play a crucial role in promoting infection in relation to their adhesive matrix molecules. The presence of pili on the surface of Gram-positive bacteria such as in different strains of Enterococcus faecalis and Streptococcus spp., grants these causative pathogens a great offensive capacity due to the formation of biofilms and resistance to antibiotics. The indications and timing of surgery in endocarditis are debated as well as the choice of the ideal valve substitute to replace the diseased valve(s) when repair is not possible. We reviewed the literature and elaborated a systematic approach to endocarditis management based on clinical, microbiological, and anatomopathological variables known to affect postoperative outcomes with the aim to stratify the patients and orient decision making. From this review emerges significant findings on the risk of infection in the allograft used in patients with endocarditis and no endocarditis etiology suggesting that the use of allografts has proved safety and effectiveness in patients with both pathologies.

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“…While most often implemented as treatment for congenital heart disease, aortic root allograft surgery has been used for treatment of aortic valve endocarditis and and has also been shown to be effective in reducing postoperative infection risks [ 18 ]. While there has been debate on the durability of cryopreserved allografts, more recent studies have found that aortic allografts have comparable durability to prosthetic valves and can last for more than 15 years with careful selection of recipients and newer implantation techniques [ 19 , 20 ]. However, underlying thoracic aortic disease is often associated with structural complications, which limits the applicability of allografts in treating type A aortic dissection and thoracic aortitis [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…While there has been debate on the durability of cryopreserved allografts, more recent studies have found that aortic allografts have comparable durability to prosthetic valves and can last for more than 15 years with careful selection of recipients and newer implantation techniques [ 19 , 20 ]. However, underlying thoracic aortic disease is often associated with structural complications, which limits the applicability of allografts in treating type A aortic dissection and thoracic aortitis [ 20 ]. Moreover, the availability of properly sized allografts also limits its use in emergent surgical cases.…”

Section: Discussionmentioning

confidence: 99%

Successful surgical treatment of Stanford type A aortic dissection due to Salmonella aortitis

Yoshida

Manerikar

Zhu

et al. 2023

J Cardiothorac Surg

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Background Salmonella spp. cause infectious aortitis through the hematogenous spread of an intestinal Salmonella infection. Salmonella aortitis can result in extensive tissue damage in the aorta leading to complications including dissection, abscess formation, pseudoaneurysms, and rupture, which require early diagnosis and treatment with both surgery and antibiotic therapy. Case presentation We report a case of Salmonella aortitis complicated by Stanford type A aortic dissection. A 62-year-old man with a history of heroin use presented with chest pain, epigastric pain and vomiting. The computed tomography scan showed Stanford type A aortic dissection without malperfusion. At the time of surgery, an aortic dissection with purulent fluid and contained rupture was noted in the ascending aorta. Fluid culture was consistent with Salmonella. A composite valve-graft conduit aortic root replacement with ascending aorta and hemiarch replacement was performed. The patient recovered well and was discharged on long-term antibiotics. Conclusions This rare case of a Stanford type A aortic dissection with contained rupture due to Salmonella aortitis was successfully treated with emergent surgery and antibiotic therapy.

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Performance and Durability of Cryopreserved Allograft Aortic Valve Replacements

Cited by 10 publications

References 27 publications

ESC guidelines 2023 on the management of endocarditis

ESC guidelines 2023 on the management of endocarditis

A Literature Review on the Use of Aortic Allografts in Modern Cardiac Surgery for the Treatment of Infective Endocarditis: Is There Clear Evidence or Is It Merely a Perception?

Successful surgical treatment of Stanford type A aortic dissection due to Salmonella aortitis

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