Aortic homografts: Should we really lose the opportunity?

Nappi, Francesco; Spadaccio, Cristiano; Chello, Massimo

doi:10.1016/j.jtcvs.2018.11.024

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…There is a paucity of data available in the literature to allow a systematic approach to plan timing and choice of valves due to the lack of randomized studies categorized in Class Ia level of evidence (LOE) A or B. 3 , 4 , 9 - 13 , 43 , 90 , 99 - 101 To date, only 1 randomized trial 99 has been published comparing patients who underwent early expedited surgery (within 48 hours) versus those who received medical therapy for severe left-sided IE (ie, large vegetations). The enrolled patients had no indications for emergency surgical correction of endocarditis, thereby resulting in a significantly lower in-hospital mortality or systemic embolization rate in the recipients who underwent surgery versus those who underwent conventional medical treatment (3% vs 23%).…”

Section: Discussionmentioning

confidence: 99%

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Nappi

Singh

Timofeeva

2020

Clin Med Insights Cardiol

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Aortic valve replacement is the commonest cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies guided by the comprehensive evaluation of the extension of the infection and its microbiological characteristics, clinical profile of the patient, and risk of infection recurrence are currently available. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. However, in cases of complex IE with the involvement of the root or the aortomitral continuity, the use of homograft is suggested according to the surgeon and center experience. Homograft use should be counterbalanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are also potentially suitable alternatives. Further development of preservation techniques enabling longer durability of allogenic substitutes is required. We evaluate the current evidence for the use of valve substitutes in aortic valve endocarditis and propose an evidence-based algorithm to guide the choice of therapy. We performed a systemic review to clarify the contemporary surgical management of aortic valve endocarditis.

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Section: Discussionmentioning

confidence: 99%

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Nappi

Singh

Timofeeva

2020

Clin Med Insights Cardiol

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“…Despite the many clinical and surgical advances achieved in the past 60 years, there is a lack of evidence regarding the ideal strategy. As the current evidence on the best treatment strategy for endocarditis does not follow a single direction and the results are controversial, a systematic approach to endocarditis management should be based on sharing of decision-making concerning clinical and ethical implications (1)(2)(3)(4)(5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Sharing of decision-making for infective endocarditis surgery: a narrative review of clinical and ethical implications

Pollari¹,

Spadaccio²,

Cuomo³

et al. 2020

Ann Transl Med

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Infective endocarditis (IE) is nowadays one of the most challenging disease in cardiac surgery because of its multifaceted clinical and anatomical presentation. Despite the many clinical and surgical advances achieved in the past 60 years, there is a lack of evidence regarding the ideal strategy. The present review aims to investigate and highlight two main novel concepts for the decision-making of the best substitute. Firstly, the concept of an "endocarditis team": a coordinated multidisciplinary effort in the diagnostic work-up, especially in conditions of high risk of embolization or clinical deterioration. A good "endocarditis team" has the role to overcome such problem, in order to ensure a prompt and balanced strategy. Secondly, which ethical considerations are required to drive the choice of valvular substitute. The choice of best valve substitute is a relevant issue of debate, not only with operative but also prognostic and accordingly ethical aftermaths. Many different solutions have been developed to substitute the infected valve. Among these: mechanical prosthesis (MP), biological stented prosthesis (BP), sutureless bioprosthesis and cryopreserved homografts (CHs). Patients need to be informed in detail about the technical issues pertaining the use of these valve substitute. We will discuss the evidences regarding the risk of recurrent infections or future potentially severe calcification of aortic homograft valve and wall (in other words, the failure of the homograft) and the difficulties in managing the reoperation.

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Porcine heart valve, aorta and trachea cryopreservation and thawing using polydimethylsiloxane

et al. 2020

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Aortic homografts: Should we really lose the opportunity?

Cited by 5 publications

References 10 publications

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

Sharing of decision-making for infective endocarditis surgery: a narrative review of clinical and ethical implications

Porcine heart valve, aorta and trachea cryopreservation and thawing using polydimethylsiloxane

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