Stentless Porcine Bioprostheses in the Treatment of Aortic Valve Infective Endocarditis

Abstract

Between January 1992 and June 1994, 23 patients underwent surgery for aortic valve endocarditis at the Department of Cardiovascular Surgery of the University of Verona; a subgroup of 10 patients underwent aortic valve replacement with a porcine stentless valve (Biocor LTDA n = 8; Toronto SPV n = 2). There were 7 males and 3 females with a mean age of 56.3 years (range, 36 to 73 years). Eight patients had active endocarditis and two had healed endocarditis. Nine patients had native valve in endocarditis, the presence of a bicuspid aortic valve in 2, and 1 patient had recurrent prosthetic valve endocarditis (PVE), 7 of whom were in New York Heart Association (NYHA) Functional Class IV. The main indications for operation were congestive cardiac failure, active sepsis, and presence of large and mobile vegetations by echo and arrhythmias. There were no operative or late mortalities in this subgroup of patients. Short-term survival is 100% at a mean follow-up time of 11.2 months (range, 4 to 18 months), with no recurrent endocarditis or valve-related complications.

Aortic root replacement with Freestyle stentless valve for complex aortic root infection

“…9 Recently, stentless porcine valves have been used to treat infectious endocarditis. 19,20 Santini and colleagues 19 reported a series of 10 cases of aortic valve infective endocarditis treated with porcine stentless valve (Biocor LTDA, Biocor Industriae e Pesquisa LtDa, Belo Horizonte, Brazil; Toronto SPV, St Jude Medical, Inc, St Paul, Minn). Our surgical strategy for managing complex aortic endocarditis is full root replacement with the Freestyle stentless valve after extensive de ´bridement of infected tissue, with closure of abscess as indicated.…”

Aortic Valve Replacement with a Stentless Bioprosthesis using the Full-Root Technique∗

“…Full root replacement appears particularly advantageous in the treatment of acute infective endocarditis with a decrease in the incidence of postoperative paravalvular leaks and recurrent endocarditis [6,14,15]. In patients with aortic valve stenosis in combination with dilatation of the ascending aorta, valve replacement using a stentless xenograft and concomitant replacement of the aorta with a Dacron prosthesis seems to be an effective surgical therapy.…”

Freestyle Stentless Bioprosthesis for Active Aortic Infectious Endocarditis with Undetermined Causative Organism

“…12,13 Regarding the resistance to infection, the superiority of the Freestyle stentless bioprosthesis over other stented bioprostheses or mechanical valves has not yet been demonstrated under an experimental analysis or clinical large-population study. Previously, Santini et al 14 suggested the efficacy of stentless porcine bioprosthesis (Biocor LTDA and Toronto SPV) in the treatment of 10 patients with aortic valve endocarditis. As for the Freestyle bioprosthesis, Katsumata et al 6 used it for three patients with active endocarditis who presented with aortic root abscess and partial or complete aorto left-ventricular discontinuity.…”