Allograft aortic root replacement in complex prosthetic endocarditis.

OBJECTIVE: To evaluate perioperative and long-term results of complex prosthetic valve endocarditis treated by allograft aortic root replacement.

METHODS: From April 1988 through February 2006, 41 patients diagnosed as prosthetic valve endocarditis (PVE) complicated by root abscess and/or periprosthetic leak, underwent fresh allograft valve replacement by root replacement. There were 37 males (89.7%) and the mean age was 51.5+/-13.7 years. The NYHA functional class was 3.0+/-0.1. Thirty-seven patients (90%) had a mechanical prosthesis and in 10 (25.6%) the PVE was recent (< 3 months). Ten patients (24.4%) underwent emergency valve replacement and four (9.8%) presented with chronic renal failure. The patients were followed for a mean of 54.3 (2-166) months and the end-points were death of the patient or allograft failure.

RESULTS: There were two hospital deaths (4.8%), both in patients with perioperative low cardiac output. Nine patients had transient acute renal failure (22.0%) but none required dialysis. Three patients (7.3%) needed pacemaker for complete A-V block. Eight patients (19.5%) died late; two died of cardiac reasons, four of non-cardiac reasons (stroke-one; acute colecystitis-two; traffic accident-two) and two of unknown cause. Two patients needed reoperation due to allograft failure at 61 and 82 months. In no case was there evidence of recurrence of endocarditis during the follow-up. The 10-year survival was 79%.

CONCLUSIONS: Allograft aortic root replacement in prosthetic endocarditis complicated by abscess and/or periprosthetic leakage carries low morbidity and mortality and, in this series, no recurrence of infection. In our experience, these results are superior to those obtained with other valvular substitutes.