Use of allogeneic tissue to treat infective valvular disease: Has everything been said?

Abstract

Mitral homograft before implant. Central Message Better a short-term solution or a long-lasting procedure in infective endocarditis? Reconsider homografts. See Editorial Commentary page 829. Scanning this QR code will take you to a video for the article.

Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis

“…Some patients may present with evidence of severe acute regurgitation or obstruction, resistant pulmonary edema and/or cardiogenic shock which usually indicate a more aggressive and wide infective colonization of the heart structure ( Figure 3). 13,65,66 Sometimes, the time to reach a diagnosis is prolonged due to the difficulty in identifying a causative pathogen. Evidence for this clinical scenario is represented when the IE sustained by predominantly intracellular microorganisms, such as C. burnetii, Bartonella species, or T. whipplei, whereby exposure and the status of the immune response of the host become key determinants.…”

“…3,10 Bucking this trend, we reported the use of homografts as a replacement for aortic and mitral valve diseased in 56.2% and 21% of patients who developed abscess formation. 4,65,66,87,89,90 Sometimes in the presence of aggressive IE with extension to the aorto-mitral junction and mitral valve, we opted for a double homograft. 4,89,107 In two-thirds of recipients, we performed a monobloc implant while one third received a separate bloc with partial mitral homograft insertion.…”

“…Some patients may present with evidence of severe acute regurgitation or obstruction, resistant pulmonary edema and/or cardiogenic shock which usually indicate a more aggressive and wide infective colonization of the heart structure ( Figure 3 ). 13 , 65 , 66 …”

Aortic homografts: Should we really lose the opportunity?

“…4 The American Association for Thoracic Surgery 2016 guidelines 5 echo these recommendations indicating CA for invasive and destructive native aortic valve IE requiring root reconstruction and replacement; however, a prosthetic bioroot or prosthetic valved conduit with a mechanical or bioprosthetic valve are considered acceptable alternatives, and the choice should be guided by surgeon training and experience. As we previously pointed out, the degree of infectious involvement of annulus and aortomitral curtain should drive the prosthesis choice and operative strategy, 6,7 and in the guidelines the use of mechanical and stented xenograft is advocated in complex IE with periannular abscess when the valve can be anchored securely to healthy and strong tissue (class IIa level of evidence B). Conversely, an allograft or a biologic tissue root has been considered preferable to a prosthetic valved conduit in case of extensive annulus destruction, extra-aortic invasion, and when radical surgery with root reconstruction is required.…”

Mitral valve restenosis after closed mitral commissurotomy: case discussion

“…In our thirty years of experience we have used a partial mitral homograft to repair the anterior leaflet. Alternatively, we have chosen an autologous pericardial patch to reconstruct mitral morphology and ensure normal leaflet coaptation (14,15,18,19) ( Figure 5).…”