Early and late results of aortic root replacement with antibiotic-sterilized aortic homograft

Okita, Yutaka; Franciosi, Giorgio; Matsuki, Osamu; Robles, Alfonso; Ross, Donald N.

doi:10.1016/s0022-5223(19)35739-3

Cited by 68 publications

(7 citation statements)

References 30 publications

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“…Although our Kaplan-Meier curve demonstrated a consistently higher mortality rate in Group ARA, this association was not statistically significant on cox regression statistical modeling (OR = 1.67; 95% CI = 0.77-3.53; p = . 19) or on review of the log-rank test (p = .17; Figure 2A). Nevertheless, we were able to identify logistic EuroSCORE (OR = 1.05; 95% CI = 1.02-1.08; p ≤ .01) and multivalvular infection (OR = 5.33; 95% CI = 1.61-17.68; p = .02) as risk factors for both inhospital and late mortality (Table 5).…”

Section: Postoperative Outcomesmentioning

confidence: 99%

Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess

Harris

Sinha

Caputo

et al. 2022

Journal of Cardiac Surgery

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Objectives: To evaluate the impact of aortic root abscess (ARA) on the postoperative outcomes of surgically managed infective endocarditis (IE) and to inform optimal surgical approach.Methods: Between 2009 and 2020, 143 consecutive patients who underwent surgical management for aortic-valve IE were included in a retrospective cohort study. Multivariable and propensity-weighted analyses were used to adjust for demographic imbalances between those without (n = 93; NARA) and with an ARA (n = 50). Additionally, empirical subgroup analysis appraised the two most used surgical techniques; patch reconstruction (PR) and aortic root replacement (ARR).Results: Demographic characteristics were similar between ARA and NARA except for logistic EuroSCORE, previous valve surgery, and multivalvular infection.In-hospital mortality was 8% and 12% in NARA and ARA, respectively (p = .38), with mortality rates consistently nonsignificantly higher in ARA across all time periods. The overall reoperation rate was also higher in ARA (27% vs. 14%; p = .09) and ARA was shown to be associated with late reoperation (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.18-6.36). Patients treated with an ARR showed a 16% increase in late mortality when compared with PR (40% vs. 24%; p = .27) and a 17% lower reoperation rate (14% vs. 31%; p = .24). Propensity-weighted analysis identified ARR as a significant protective factor for reoperation (hazard ratio = 0.05; 95% CI = 0.01-0.34). Conclusions:The presence of an ARA in aortic valve endocarditis was not associated with significantly higher early and late mortality but is linked with a higher reoperation rate at our institution. ARR in ARA is protective from reoperation so should be considered best practice in this setting.

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Section: Postoperative Outcomesmentioning

confidence: 99%

Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess

Harris

Sinha

Caputo

et al. 2022

Journal of Cardiac Surgery

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“…The allograft was attached to the aortic outflow tract using iinterrupted stitches of 3-0 polypropylene suture with a thin strip of Teflon felt tied within the suture loops after the method of Ross. 6 The defect in the roof of the left atrium was closed with a patch of aorta taken from the allograft (Fig. lD), which was sutured to the allograft and the left atrium with continuous stitches of 3-0 polypropylene.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Aortic Valve Replacement and Mitral Valve Repair with Allograft

Milsom¹,

Doty²

1993

J Cardiac Surgery

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Techniques of repair of defects in the anterior leaflet of the mitral valve and replacement of the aortic valve using allograft are presented. The case history and operative procedure of a reconstructive operation that did not require anticoagulant therapy after surgery are described for three adult patients. Mitral valve defects were repaired using the anterior leaflet of the mitral valve of the allograft. The aortic valve or entire root was replaced with the aortic allograft. The aortic/mitral allograft should be considered as an alternative to replacement of the aortic and mitral valves with prostheses in selected patients.

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“…2 The first free-standing aortic root was used in 1972 in a case of aortic root abscess, in which there was aorto-left ventricular discontinuity. 3 The pus was evacuated, the ventricle and aorta were re-anastomosed to a homograft root and the coronaries were reimplanted. While there were still early learning problems and difficulties in inserting a subcoronary replacement, the concept of using a free-standing root replacement was increasingly appealing, since it almost guarantees a competent valve.…”

mentioning

confidence: 99%

Choice of Valves — Homografts

Ross

2000

Asian Cardiovasc Thorac Ann

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EDITORIALThe original biological aortic valve replacement was, of course, the homograft introduced in 1962. 1 These valves were all inserted in a subcoronary position and it took some years and painstaking appraisal before they could be inserted with a satisfactory degree of competence. In other words, there was an early learning curve but the lessons learnt are still applicable today.Among other considerations, the initial sizing of the homograft is of importance and it should be remembered that the given size of a homograft means the internal diameter. If to this we add the thickness of the wall, then the effective external diameter of the implant will be 2 to 3 mm larger. This fact should be kept in mind. Also, a double-layer suture insertion is commonly used together with interrupted sutures at the lower margin and a continuous suture along the upper margin, ensuring that the commissures are elevated under some tension to prevent subsequent cusp prolapse. Finally, the noncoronary sinus is kept intact to maintain the spatial relationships between the adjacent commissures, which is an important feature in achieving competence. With these guidelines, it is certainly possible to achieve a competent subcoronary valve placement, whether it is a homograft, autograft, or xenograft but, because of the initial learning curve, many surgeons wishing to use a biological valve opted for the less satisfactory and bulky stented variety. 2 The first free-standing aortic root was used in 1972 in a case of aortic root abscess, in which there was aorto-left ventricular discontinuity. 3 The pus was evacuated, the ventricle and aorta were re-anastomosed to a homograft root and the coronaries were reimplanted. While there were still early learning problems and difficulties in inserting a subcoronary replacement, the concept of using a free-standing root replacement was increasingly appealing, since it almost guarantees a competent valve. 4 This applies even in relatively inexperienced hands and, not surprisingly, the technique is used almost exclusively in the autograft operation.Scanning the surgical journals over the years, it has been fascinating to read what is supposed to constitute a longterm valve follow-up: sometimes it is 3 years, sometimes 5, and others talk of long-term follow-up with two or three patients available for assessment at about 7 to 8 years in the case of many of the so-called stentless valves. The thing we have learned from our considerable experience with over 2,000 homograft valves, is that 7 years is the watershed which determines whether the valve will continue to function satisfactorily ("7-year itch"). Up to that point, all valves are excellent, so to make a reasonable assessment one needs a satisfactory cohort of patients at least 10 years and preferably 20 years post-implantation.Homograft valves are collected from cadavers under 45 years of age, (preferably, nearer 20 years) and processed within 24 hours of death when the body has been kept in a morgue refrigerator. They are then either stored for ...

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Early and late results of aortic root replacement with antibiotic-sterilized aortic homograft

Cited by 68 publications

References 30 publications

Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess

Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess

Aortic Valve Replacement and Mitral Valve Repair with Allograft

Choice of Valves — Homografts

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