Valve selection in aortic valve endocarditis

Perrotta, Sossio; Zubrytska, Yana

doi:10.5114/kitp.2016.62605

Cited by 6 publications

(10 citation statements)

References 39 publications

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“…Stentless bioroots have proven to be a viable alternative, the design facilitating reconstructive procedures at annular level and hemodynamic superiority by omission of the obstructive elements [ 16 ] . A review by Perrotta et al [ 4 , 17 ] show stentless valves to have a low reinfection rate of 3.7% to 8.6%, comparable to homografts. Siniawski et al [ 6 ] compared patients receiving Shelhigh prostheses to homografts, showing good results for postoperative gradients and echocardiographic variables.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with infective endocarditis represent a high-risk cohort with significant mortality [ 1 , 2 ] , and early diagnosis/radical surgical treatment in the acute phase of endocarditis remains the gold standard treatment. Aggressive debridement of infected tissue is mandatory, often leading to severe defects of the outflow tract requiring complex reconstructive procedures [ 3 , 4 ] . The debate about prosthesis choice in this setting has been ongoing and is dependent on several factors influencing long-term performance.…”

Section: Introductionmentioning

confidence: 99%

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Stentless Root Replacement versus Tissue Valves in Infective Endocarditis – A Propensity-Score Matched Study

Easo¹,

Szczechowicz²,

Hölzl³

et al. 2020

Braz J Cardiovasc Surg

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Introduction People with aortic/prosthetic valve endocarditis are a high-risk cohort of patients who present a challenge for all medically involved disciplines and who can be treated by various surgical techniques. Methods We analyzed the results of treatment of root endocarditis with Medtronic Freestyle® in full-root technique over 19 years (1999-2018) and compared them against treatment with other tissue valves. Comparison was made with propensity score matching, using the nearest neighbor method. Various tests were performed as suited for adequate analyses. Results Fifty-four patients in the Medtronic Freestyle group (FS group) were matched against 54 complex root endocarditis patients treated with other tissue valves (Tissue group). Hospital mortality was 9/54 (16.7%) in the FS group vs . 14/54 (25.6%) in the Tissue group ( P =0.24). Cox regression performed for early results demonstrated coronary heart disease ( P =0.004, odds ratio 2.3), among others, influencing early mortality. Recurrent infection was low (1.8% for FS and Tissue patients) and freedom from reoperation was 97.2% at a total of 367 patient-years of follow-up (median of 2.7 years). Conclusion The stentless xenograft is a viable alternative for treatment of valve/root/prosthetic endocarditis, demonstrating a low rate of reinfection. The design of the bioroot allows for complex reconstructive procedures at the outflow tract and the annular level with at an acceptable operative risk. Endocarditis patients can be treated excluding infective tissue from the bloodstream, possibly with benefits, concerning bacteremia and recurrent infection. Furthermore, the use of the stentless bioroot offers varying treatment options in case of future valve degeneration.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stentless Root Replacement versus Tissue Valves in Infective Endocarditis – A Propensity-Score Matched Study

Easo¹,

Szczechowicz²,

Hölzl³

et al. 2020

Braz J Cardiovasc Surg

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“…Introduced in 1965 by Wallace [68]; its surgical treatment is performed often in emergency mode. Radical removal of the native or prosthetic valve and necrotic tissues, supported with intensive antibiotic therapy and local disinfection, is inarguable [62,[69][70][71], but it does not exist consensus for the choice of valve substitute. Mostly are used, widely accessible and easy to implant, mechanical or bioprosthetic valves [69,72,73], while a large literature expresses excellent opinions on AVA, presented better resistance for infection and transparency for antibiotics [6,62,[69][70][71][74][75][76].…”

Section: Indications For Ava Implantationmentioning

confidence: 99%

Perspective Chapter: Role of Frozen Allografts in Aortic Valve Surgery

Pfitzner¹

2022

Aortic Stenosis - Recent Advances, New Perspectives and Applications

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Although, the mechanical and bioprosthetic valves, of good parameters, availability and easy of implantation, are universally applied as substitutes for failed aortic valve, the usefulness of aortic valve allografts (AVA); natural, viable, unstented human valves, is still considered. The essential technology for their preparation is cryopreservation, which allows for long-term storage. Hemodynamic functions of AVA are like of native valve, they do not produce hemolysis nor thromboembolism. Being markedly resistant for infection, AVA are recommended as the optimal grafts for severe endocarditis. Indeed, there exist some disadvantages, such as low availability, need for a specialized laboratories; implantation may be a challenge. Therefore, AVA are not recommended for routine use. Their important limitation is durability, affected with degenerative processes, characteristic of biological implants. Nevertheless, AVA presented satisfactory clinical results after 10, 20, and more years. This chapter have been discussed in detail the principal issues, connected with AVA, including preparation technologies, indications for use, surgical techniques, and first of all, clinical results.

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“…КЛИНИЧЕСКИЕ СЕМИНАРЫ § В случае с протезным ИЭ частота выявления до настоящего времени является очень низкой -всего 1-6 % [27]. В связи с этим требуется выработанная стратегия диагностики, которая должна быть, с одной стороны, чувствительной к различным проявлениям заболевания, а с другой -достаточно специфичной, чтобы его исключить.…”

Section: диагностикаunclassified

Infective Endocarditis Causing Native and Prosthetic Heart Valve Dysfunction

et al. 2019

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Infective endocarditis (IE) is the disease that has high inhospital mortality. Heart valves dysfunction – both native and prosthetic – is the primary IE complication requiring a surgical intervention. The IE causes and its course have been discussed in this review. In particular, the role of concomitant infectious foci in the formation and development of IE have been considered, the mechanisms of mutual transition of subacute and acute clinical forms have been described. Modern diagnostic principles and methods based on the Duke criteria system have been mentioned, as well as the difficulties that follow the patient’s clinical status evaluation. The normobiotic microbiota participation, as well as the possibilities for their identification using blood culture and PCR technique, have been closely reviewed. According to modern researches and publications, there have been made the conclusion about the contribution of obligate anaerobic bacteria, fungi and viruses to the development of endocarditis. There have been described the hypothesis about the presumptive strategy for the cardiac dysfunction formation as a result of the IE causative agents cells metabolic activity based on a literature data analysis in the article: vegetation formed by Staphylococcus aureus can lead to the heart valve stenosis, and the influence of hyaluronidases, collagenases on a heart valve structure can lead to regurgitation. The pathogens cells ability to avoid the human immune system response is caused by the biofilms, fibrin vegetations formation and the enzymes production – cytotoxins (streptolysins, leukocidin, etc.). It has been suggested that the mediators of inflammation and leukocyte cells participate in the destruction of native and prosthetic tissues due to an IE pathogens inaccessibility for immunocompetent cells.

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Valve selection in aortic valve endocarditis

Cited by 6 publications

References 39 publications

Stentless Root Replacement versus Tissue Valves in Infective Endocarditis – A Propensity-Score Matched Study

Stentless Root Replacement versus Tissue Valves in Infective Endocarditis – A Propensity-Score Matched Study

Perspective Chapter: Role of Frozen Allografts in Aortic Valve Surgery

Infective Endocarditis Causing Native and Prosthetic Heart Valve Dysfunction

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