Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis: A 12-year experience in high-risk patients

Ourania Preventza, Ahmed S. Mohamed, Denton A. Cooley, Victor Rodriguez, Faisal G. Bakaeen, Lorraine D. Cornwell, Shuab Omer, Joseph S. Coselli

Research output: Contribution to journalArticle

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Abstract

Objectives We examined the early and midterm outcomes of homograft use in reoperative aortic root and proximal aortic surgery for endocarditis and estimated the associated risk of postoperative reinfection. Methods From January 2001 to January 2014, 355 consecutive patients underwent reoperation of the proximal thoracic aorta. Thirty-nine patients (10.9%; mean age, 55.4 ± 13.3 years) presented with active endocarditis; 30 (76.9%) had prosthetic aortic root infection with or without concomitant ascending and arch graft infection, and 9 (23.1%) had proximal ascending aortic graft infection with or without aortic valve involvement. Sixteen patients (41.0%) had genetically triggered thoracic aortic disease. Twelve patients (30.8%) had more than 1 prior sternotomy (mean, 2.4 ± 0.6). Results Valved homografts were used to replace the aortic root in 29 patients (74.4%); nonvalved homografts were used to replace the ascending aorta in 10 patients (25.6%). Twenty-five patients (64.1%) required concomitant proximal arch replacement with a homograft, and 2 patients (5.1%) required a total arch homograft. Median cardiopulmonary bypass, cardiac ischemia, and circulatory arrest times were 186 (137-253) minutes, 113 (59-151) minutes, and 28 (16-81) minutes. Operative mortality was 10.3% (n = 4). The rate of permanent stroke was 2.6% (n = 1); 3 additional patients had transient neurologic events. One patient (1/35, 2.9%) returned with aortic valve stenosis 10 years after the homograft operation. During the follow-up period (median, 2.5 years; range, 1 month to 12.3 years), no reinfection was reported, and survival was 65.7%. Conclusions This is one of the largest North American single-center series of homograft use in reoperations on the proximal thoracic aorta to treat active endocarditis. In this high-risk population, homograft tissue can be used with acceptable early and midterm survival and a low risk of reinfection. When necessary, homograft tissue may be extended into the distal ascending and transverse aortic arch, with excellent results. These patients require long-term surveillance for both infection and implant durability.

Original languageEnglish (US)
Pages (from-to)989-994
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume148
Issue number3
DOIs
StatePublished - 2014
Externally publishedYes

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compound A 12
Endocarditis
Allografts
Thoracic Aorta
Infection
Reoperation
Thoracic Diseases
Transplants
Aortic Diseases
Sternotomy
Survival
Aortic Valve Stenosis
Cardiopulmonary Bypass
Aortic Valve
Nervous System
Aorta
Ischemia
Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis : A 12-year experience in high-risk patients. / Preventza, Ourania; Mohamed, Ahmed S.; Cooley, Denton A.; Rodriguez, Victor; Bakaeen, Faisal G.; Cornwell, Lorraine D.; Omer, Shuab; Coselli, Joseph S.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 148, No. 3, 2014, p. 989-994.

Research output: Contribution to journalArticle

Preventza, Ourania ; Mohamed, Ahmed S. ; Cooley, Denton A. ; Rodriguez, Victor ; Bakaeen, Faisal G. ; Cornwell, Lorraine D. ; Omer, Shuab ; Coselli, Joseph S. / Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis : A 12-year experience in high-risk patients. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 148, No. 3. pp. 989-994.
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abstract = "Objectives We examined the early and midterm outcomes of homograft use in reoperative aortic root and proximal aortic surgery for endocarditis and estimated the associated risk of postoperative reinfection. Methods From January 2001 to January 2014, 355 consecutive patients underwent reoperation of the proximal thoracic aorta. Thirty-nine patients (10.9{\%}; mean age, 55.4 ± 13.3 years) presented with active endocarditis; 30 (76.9{\%}) had prosthetic aortic root infection with or without concomitant ascending and arch graft infection, and 9 (23.1{\%}) had proximal ascending aortic graft infection with or without aortic valve involvement. Sixteen patients (41.0{\%}) had genetically triggered thoracic aortic disease. Twelve patients (30.8{\%}) had more than 1 prior sternotomy (mean, 2.4 ± 0.6). Results Valved homografts were used to replace the aortic root in 29 patients (74.4{\%}); nonvalved homografts were used to replace the ascending aorta in 10 patients (25.6{\%}). Twenty-five patients (64.1{\%}) required concomitant proximal arch replacement with a homograft, and 2 patients (5.1{\%}) required a total arch homograft. Median cardiopulmonary bypass, cardiac ischemia, and circulatory arrest times were 186 (137-253) minutes, 113 (59-151) minutes, and 28 (16-81) minutes. Operative mortality was 10.3{\%} (n = 4). The rate of permanent stroke was 2.6{\%} (n = 1); 3 additional patients had transient neurologic events. One patient (1/35, 2.9{\%}) returned with aortic valve stenosis 10 years after the homograft operation. During the follow-up period (median, 2.5 years; range, 1 month to 12.3 years), no reinfection was reported, and survival was 65.7{\%}. Conclusions This is one of the largest North American single-center series of homograft use in reoperations on the proximal thoracic aorta to treat active endocarditis. In this high-risk population, homograft tissue can be used with acceptable early and midterm survival and a low risk of reinfection. When necessary, homograft tissue may be extended into the distal ascending and transverse aortic arch, with excellent results. These patients require long-term surveillance for both infection and implant durability.",
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T1 - Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis

T2 - A 12-year experience in high-risk patients

AU - Preventza, Ourania

AU - Mohamed, Ahmed S.

AU - Cooley, Denton A.

AU - Rodriguez, Victor

AU - Bakaeen, Faisal G.

AU - Cornwell, Lorraine D.

AU - Omer, Shuab

AU - Coselli, Joseph S.

PY - 2014

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N2 - Objectives We examined the early and midterm outcomes of homograft use in reoperative aortic root and proximal aortic surgery for endocarditis and estimated the associated risk of postoperative reinfection. Methods From January 2001 to January 2014, 355 consecutive patients underwent reoperation of the proximal thoracic aorta. Thirty-nine patients (10.9%; mean age, 55.4 ± 13.3 years) presented with active endocarditis; 30 (76.9%) had prosthetic aortic root infection with or without concomitant ascending and arch graft infection, and 9 (23.1%) had proximal ascending aortic graft infection with or without aortic valve involvement. Sixteen patients (41.0%) had genetically triggered thoracic aortic disease. Twelve patients (30.8%) had more than 1 prior sternotomy (mean, 2.4 ± 0.6). Results Valved homografts were used to replace the aortic root in 29 patients (74.4%); nonvalved homografts were used to replace the ascending aorta in 10 patients (25.6%). Twenty-five patients (64.1%) required concomitant proximal arch replacement with a homograft, and 2 patients (5.1%) required a total arch homograft. Median cardiopulmonary bypass, cardiac ischemia, and circulatory arrest times were 186 (137-253) minutes, 113 (59-151) minutes, and 28 (16-81) minutes. Operative mortality was 10.3% (n = 4). The rate of permanent stroke was 2.6% (n = 1); 3 additional patients had transient neurologic events. One patient (1/35, 2.9%) returned with aortic valve stenosis 10 years after the homograft operation. During the follow-up period (median, 2.5 years; range, 1 month to 12.3 years), no reinfection was reported, and survival was 65.7%. Conclusions This is one of the largest North American single-center series of homograft use in reoperations on the proximal thoracic aorta to treat active endocarditis. In this high-risk population, homograft tissue can be used with acceptable early and midterm survival and a low risk of reinfection. When necessary, homograft tissue may be extended into the distal ascending and transverse aortic arch, with excellent results. These patients require long-term surveillance for both infection and implant durability.

AB - Objectives We examined the early and midterm outcomes of homograft use in reoperative aortic root and proximal aortic surgery for endocarditis and estimated the associated risk of postoperative reinfection. Methods From January 2001 to January 2014, 355 consecutive patients underwent reoperation of the proximal thoracic aorta. Thirty-nine patients (10.9%; mean age, 55.4 ± 13.3 years) presented with active endocarditis; 30 (76.9%) had prosthetic aortic root infection with or without concomitant ascending and arch graft infection, and 9 (23.1%) had proximal ascending aortic graft infection with or without aortic valve involvement. Sixteen patients (41.0%) had genetically triggered thoracic aortic disease. Twelve patients (30.8%) had more than 1 prior sternotomy (mean, 2.4 ± 0.6). Results Valved homografts were used to replace the aortic root in 29 patients (74.4%); nonvalved homografts were used to replace the ascending aorta in 10 patients (25.6%). Twenty-five patients (64.1%) required concomitant proximal arch replacement with a homograft, and 2 patients (5.1%) required a total arch homograft. Median cardiopulmonary bypass, cardiac ischemia, and circulatory arrest times were 186 (137-253) minutes, 113 (59-151) minutes, and 28 (16-81) minutes. Operative mortality was 10.3% (n = 4). The rate of permanent stroke was 2.6% (n = 1); 3 additional patients had transient neurologic events. One patient (1/35, 2.9%) returned with aortic valve stenosis 10 years after the homograft operation. During the follow-up period (median, 2.5 years; range, 1 month to 12.3 years), no reinfection was reported, and survival was 65.7%. Conclusions This is one of the largest North American single-center series of homograft use in reoperations on the proximal thoracic aorta to treat active endocarditis. In this high-risk population, homograft tissue can be used with acceptable early and midterm survival and a low risk of reinfection. When necessary, homograft tissue may be extended into the distal ascending and transverse aortic arch, with excellent results. These patients require long-term surveillance for both infection and implant durability.

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