Homograft valve replacement for native and prosthetic aortic valve endocarditis

Abstract

Between September, 1992 and September, 1995, 4 patients with native or prosthetic val¬ve endocarditis underwent homograft replacement of the aortic valve. 1 patient, who had had a Starr-Ed¬wards mechanical valve prosthesis 20 years ago, received homograft aortic valve due to destructive prost¬hetic valve endocarditis. 2 of the patients who had native valve endocarditis were also complicated with acute renal insufficiency in the preoperative period. One of them underwent also mitral and tricuspid valve annuloplasty besides the aortic homograft valve replacement. 1 patient with native valve endocarditis underwent a successful Ross procedure with pulmonary autograft instead of the aortic valve and pulmonary homograft for the pulmonary valve. All the patients were well, without clinical or echocardiographic evidence of aortic incompetence and in NYHA functional class in the postoperative period. Infective endocarditis, especially in active native and prosthetic valve infection, is still a difficult surgical intervention. The operative mortality rate in complicated active infective endocarditis, like in patients with cardiac failure, sepsis or both, is still high (10-35 %). The viable homograft appears to have the greatest resistance to endocarditis, therefore it is the valve of choice for bacterial endocarditis affecting the native or prosthetic aortic valves. The aortic homograft immediately offers excellent hemodynamics'of a totally competent valve and restores normal anatomy. We believe that homograft replacement of the aortic valve gives satisfactory results in native and prosthetic valve endocarditis with a very low incidence of valve related complications.