Allograft aortic valve replacement for infective endocarditis yielded higher 11-year survival (82.1% vs 64.7%) and lower 30-day mortality (8.5% vs 23.5%) compared to prosthetic valves.
Cohort (n=65)
Does aortic valve replacement with allografts improve survival and reduce recurrent infections compared to prosthetic valves in patients with active infective aortic valve endocarditis and periannular abscess?
Aortic allografts demonstrate superior long-term survival and lower rates of recurrent infection and operative mortality compared to prosthetic valves in patients with active infective aortic valve endocarditis and periannular abscess.
Absolute Event Rate: 82.1% vs 64.7%
AIMS: The aim of the study was to evaluate the long-term results of allograft and prosthetic valve replacement in the treatment of infective aortic valve endocarditis with periannular abscess. METHODS: Between March 1988 and March 1996, 65 patients underwent surgery for active aortic valve endocarditis and paravalvular abscess. The indications for surgery were congestive heart failure, systemic emboli and atrioventricular block III. The pre-operative evaluation was performed with transoesophageal echocardiography. Aortic valve replacement was performed with allografts in 47 cases, with mechanical valves in 15, and bioprosthetic valves in three cases. All patients with total ventricular-aortic dehiscence and prosthetic valve endocarditis were treated with allografts. RESULTS: The 30-day mortality rate was 23.5% in the prosthetic group, when compared with 8.5% in the patients treated with allografts. The rate of recurrent valve infections during the 11-year follow-up period was 27.1% in the prosthetic group and 3.2% in the allograft group. The actuarial 11-year survival rate was 82.1% in the allograft group and 64.7% in the prosthetic group. CONCLUSION: Aortic allografts are an effective treatment for infective aortic valve endocarditis with associated periannular abscess. The operative mortality and recurrent infection rates are lower than in the prosthetic group, resulting in a significantly higher survival rate. Diagnosis and surgical management of these cases should be based on pre-operative transoesophageal echocardiography.
Christoph Knosalla (2000) conducted a cohort in Active infective aortic valve endocarditis with paravalvular abscess (n=65). Aortic valve replacement with allografts vs. Prosthetic valve replacement was evaluated on Actuarial 11-year survival rate. Allograft aortic valve replacement for infective endocarditis yielded higher 11-year survival (82.1% vs 64.7%) and lower 30-day mortality (8.5% vs 23.5%) compared to prosthetic valves.