Ibrahim Sultan1, Valentino Bianco2, Arman Kilic2, Danny Chu2, Forozan Navid2, Thomas G Gleason2. 1. Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: sultani@upmc.edu. 2. Division of Cardiac Surgery, University of Pittsburgh and Heart and Vascular Institute, Univeristy of Pittsburgh Medical Center, Pittsburgh, Pa.
Abstract
OBJECTIVE: To study mid-term survival in patients with infective endocarditis as a result of IV drug use undergoing aortic root replacement with cryopreserved aortic homograft. METHODS: Patients undergoing aortic root homograft replacement from 2011-2017 were studied retrospectively. Aortic root replacement was performed using a modified Bentall technique. Primary outcomes included both short-term and mid-term survival. Secondary outcomes included immediate postoperative complications. RESULTS: A total of 138 patients underwent cryopreserved homograft replacement of the aortic root for aortic root abscesses. Eighty-five patients (61.6%) underwent reoperative sternotomy, and 12 patients (8.7%) underwent second or third reoperative sternotomy. Sixty-seven (48.5%) patients had severe aortic insufficiency preoperatively. Operative mortality was 12.3% (17 patients). Five patients (3.6%) sustained a permanent stroke. Twenty-one patients (15.2%) required dialysis for renal failure, and 21 patients (15.2%) had complete heart block necessitating a permanent pacemaker. Estimated 5-year mortality for the cohort was 43%. CONCLUSIONS: Cryopreserved homograft replacement is a safe and desirable option for high-risk patients with infective endocarditis and aortic root abscess. Homograft accommodation for a widely debrided aortic annular bed provides a reasonable surgical strategy for patients needing aortic root replacement with annular abscess.
OBJECTIVE: To study mid-term survival in patients with infective endocarditis as a result of IV drug use undergoing aortic root replacement with cryopreserved aortic homograft. METHODS:Patients undergoing aortic root homograft replacement from 2011-2017 were studied retrospectively. Aortic root replacement was performed using a modified Bentall technique. Primary outcomes included both short-term and mid-term survival. Secondary outcomes included immediate postoperative complications. RESULTS: A total of 138 patients underwent cryopreserved homograft replacement of the aortic root for aortic root abscesses. Eighty-five patients (61.6%) underwent reoperative sternotomy, and 12 patients (8.7%) underwent second or third reoperative sternotomy. Sixty-seven (48.5%) patients had severe aortic insufficiency preoperatively. Operative mortality was 12.3% (17 patients). Five patients (3.6%) sustained a permanent stroke. Twenty-one patients (15.2%) required dialysis for renal failure, and 21 patients (15.2%) had complete heart block necessitating a permanent pacemaker. Estimated 5-year mortality for the cohort was 43%. CONCLUSIONS: Cryopreserved homograft replacement is a safe and desirable option for high-risk patients with infective endocarditis and aortic root abscess. Homograft accommodation for a widely debrided aortic annular bed provides a reasonable surgical strategy for patients needing aortic root replacement with annular abscess.
Authors: Mahbub Jamil; Ibrahim Sultan; Thomas G Gleason; Forozan Navid; Michael A Fallert; Matthew S Suffoletto; Arman Kilic Journal: J Thorac Dis Date: 2019-11 Impact factor: 2.895
Authors: Bo Yang; Juan Caceres; Linda Farhat; Tan Le; Bailey Brown; Emma St Pierre; Xiaoting Wu; Karen M Kim; Himanshu J Patel; G Michael Deeb Journal: J Thorac Cardiovasc Surg Date: 2020-04-13 Impact factor: 6.439