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Donato F, Donati T, Minelli F, Borghetti A, Minucci M, Luparelli A, Tinelli G, Tshomba Y. Treatment of Aorto-iliac and Infrainguinal Vascular Infections with a Prefabricated Bovine Pericardial Graft. Ann Vasc Surg 2024; 105:177-188. [PMID: 38599483 DOI: 10.1016/j.avsg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The use of biological grafts provides acceptable mid- and long-term results in native or prosthetic vascular infections. Several reports describe the successful use of bovine pericardium in case of vascular infections, mainly as a large patch to be sutured as a tubular graft. Recently, a novel prefabricated bovine pericardium graft (Biointegral Surgical No-React® Inc, Mississauga, ON, Canada) has been introduced in clinical practice with promising results. In this study, we report our preliminary experience utilizing Biointegral Surgical graft in case of native and or prosthetic aorto-iliac and infrainguinal infection. METHODS We retrospectively analyzed data from 20 patients with native or prosthetic aorto-iliac and infrainguinal infection who underwent in situ reconstruction (ISR) with a Biointegral Surgical No-React bovine pericardium prosthesis between October 2020 and February 2023 at the Vascular Surgery Unit of the Fondazione Policlinico Universitario Gemelli - IRCCS in Rome, Italy. All patients followed a standardized protocol including postoperative anticoagulation and long-term intravenous antibiotics. RESULTS The indication for surgery was: mycotic aortic aneurysm in 4 patients (20%), graft infection after abdominal aortic repair in 11 patients (55%), peripheral graft infection in 5 patients (25%). Complete excision of the infected aorta or prosthetic graft, surgical debridement and ISR were performed in all patients. Hospital mortality rate was 5% (n = 1) and graft-related mortality of 0%. During follow-up (median 13 months, range 6-34 months), reinfection was 5.2% and primary graft patency 94.7%. CONCLUSIONS The use of prefabricated bovine pericardial grafts represents a promising option for the treatment of native and prosthetic aorto-iliac and infrainguinal infections. The application of this biological graft with a standardized postoperative protocol has been associated with a satisfactory patency and reinfection rate without increased bleeding complications.
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Affiliation(s)
- Federica Donato
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Tommaso Donati
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Minelli
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alberto Borghetti
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Infectious Diseases, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marta Minucci
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Luparelli
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Tinelli
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yamume Tshomba
- Dipartimento Cardiovascolare, Università Cattolica del Sacro Cuore, Rome, Italy; Unit of Vascular Surgery, Fondazione Policlinico Universitario Gemelli IRCCS, Roma - Università Cattolica del Sacro Cuore, Rome, Italy
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2
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Weiss S, Hugas Mallorqui M, Czerny M, Walter T, Biro G, Puttini I, Almasi-Sperling V, Lang W, Schmidli J, Wyss TR. Physician Made Bovine Pericardial Tube Grafts in Aortic Infection: A European Multicentre Study. Eur J Vasc Endovasc Surg 2024; 67:997-1005. [PMID: 38341175 DOI: 10.1016/j.ejvs.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE This study examines outcome and durability of physician made bovine pericardial tube grafts in aortic infections in all anatomical locations. METHODS This was a retrospective and prospective international multicentre study. Peri-operative and long term outcomes of patients undergoing in situ aortic reconstruction for native or graft infections with physician made bovine pericardial tube grafts between January 2008 and December 2020 in four European tertiary referral centres were analysed. The primary endpoint was recurrent aortic infection. Secondary endpoints were persistent infection, aortic re-operation for infection, graft related complications, and death. RESULTS One hundred and sixty eight patients (77% male, mean age 67 ± 11 years) were identified: 38 (23%) with native and 130 (77%) with aortic graft infection. The thirty day mortality rate was 15% (n = 26) overall, 11% (n = 4), and 17% (n = 22) for native and aortic graft infections, respectively (p = .45). Median follow up was 26 months (interquartile range [IQR] 10, 51). Estimated survival at one, two, three, and five years was 64%, 60%, 57%, and 50%, and significantly better for native (81%, 77%, 77%, and 69%) than for graft infections (58%, 55%, 51%, and 44%; p = .011). Nine patients (5.3%) had persistent infection and 10 patients (6%) had aortic re-infection after a median of 10 months (IQR 5, 22), resulting in an estimated freedom from re-infection at one, two, three, and five years of 94%, 92%, 90%, and 86%. Estimated freedom from graft complications at one, two, three, and five years was 91%, 89%, 87%, and 87%. CONCLUSION This multicentre study demonstrates low re-infection rates when using physician made bovine pericardial tube grafts, comparable to those of other biological grafts. The rate of graft complications, mainly anastomotic aneurysms and stenoses, was low, while graft degeneration was absent. Physician made bovine pericardial tube grafts are an excellent tool for in situ reconstruction in the setting of native aortic infection or aortic graft infection.
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Affiliation(s)
- Salome Weiss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Maria Hugas Mallorqui
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Czerny
- Clinic for Cardiovascular Surgery, University Heart Centre Freiburg - Bad Krozingen, Freiburg University Hospital, Freiburg, Germany; Faculty of Medicine, Albert Ludwig's University of Freiburg, Freiburg, Germany
| | - Tim Walter
- Clinic for Cardiovascular Surgery, University Heart Centre Freiburg - Bad Krozingen, Freiburg University Hospital, Freiburg, Germany; Faculty of Medicine, Albert Ludwig's University of Freiburg, Freiburg, Germany
| | - Gabor Biro
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Ilaria Puttini
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Werner Lang
- Department of Vascular Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Jürg Schmidli
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
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3
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Botea R, Lavie-Badie Y, Goicea A, Porterie J, Marcheix B. Early and midterm outcomes of a bentall operation using an all-biological valved BioConduit™. J Cardiothorac Surg 2022; 17:325. [PMID: 36536442 PMCID: PMC9761648 DOI: 10.1186/s13019-022-02073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To analyze the midterm results of aortic root replacement using the valved, all biological, No React®, BioConduit™. METHODS From 2017 to 2020, we prospectively followed 91 consecutive patients who underwent a Bentall procedure with a BioConduit™ valved graft in our institution. The primary outcomes were aortic bioprosthetic valve dysfunction and mortality according to Valve Academic Research Consortium 3 (VARC3). RESULTS Mean age was 70 ± 10 years and 67 patients (74%) were men. Ascending aortic aneurysm (72%), aortic valve regurgitation (51%) or stenosis (20%) and acute endocarditis (14%) were the main indications for surgery. Seventy-four patients (81.3%) were followed up at 1 year. The perioperative mortality was 8% (n = 8), the early, 1 year, mortality was 2% (n = 2) and the midterm mortality, at 4 years of follow up, was 4% (n = 3). Ten patients fulfilled the criteria for hemodynamic valve deterioration at 1 year (13%) and 14 for a bioprosthetic valve failure during the entire follow-up (17%). CONCLUSIONS We are reporting early and midterm results of Bentall procedures with the all-biological, valved, No-React® BioConduit™. To our knowledge, this is the first study reporting an early and midterm unexpectedly high rate of non-structural prosthetic hemodynamic deterioration. The rate of endocarditis and atrioventricular disconnections remain similar to previous studies.
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Affiliation(s)
- Roxana Botea
- grid.414295.f0000 0004 0638 3479Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France ,grid.414295.f0000 0004 0638 3479Department of Cardiology, Rangueil University Hospital, 1, Avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex, France
| | - Yoan Lavie-Badie
- grid.414295.f0000 0004 0638 3479Department of Cardiology, Rangueil University Hospital, 1, Avenue Jean Poulhès, TSA 50032, 31059 Toulouse Cedex, France
| | - Alexandru Goicea
- grid.414295.f0000 0004 0638 3479Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France ,Department of Cardiovascular Surgery, Nicolae Stancioiu Heart Institute, Cluj-Napoca, Romania
| | - Jean Porterie
- grid.414295.f0000 0004 0638 3479Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
| | - Bertrand Marcheix
- grid.414295.f0000 0004 0638 3479Department of Cardiovascular Surgery, Rangueil University Hospital, Toulouse, France
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Schmidli J, Wyss TR. Self-made bovine pericardial tube grafts: maybe the best thing since sliced bread. Eur J Cardiothorac Surg 2021; 60:162-163. [PMID: 34125171 DOI: 10.1093/ejcts/ezab067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Interventional Radiology and Vascular Surgery, Cantonal Hospital, Winterthur, Switzerland
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5
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Rapetto F, Caputo M, Angelini GD. Surgical reconstruction of the right ventricular outflow tract-The clock is still ticking. J Card Surg 2021; 36:3153-3154. [PMID: 34057241 DOI: 10.1111/jocs.15685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Massimo Caputo
- Bristol Heart Institute, University of Bristol, Bristol, UK
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6
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Selcuk A, Kilic Y, Korun O, Yurdakok O, Cicek M, Altin HF, Altuntas Y, Yilmaz EH, Sasmazel A, Aydemir NA. High incidence of fever in patients after biointegral pulmonic valved conduit implantation. J Card Surg 2021; 36:3147-3152. [PMID: 34056764 DOI: 10.1111/jocs.15683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/02/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe our short- and medium-term outcomes using the BioIntegral pulmonic conduit. METHODS Between August 2018 and September 2019, the BioIntegral pulmonic valved conduit was used for right ventricular outflow tract reconstruction in 48 patients. The data were retrospectively retrieved from the patient charts. RESULTS The median age at surgery was 36 months (interquartile range [IQR] = 18-62 months). The diagnoses were pulmonary atresia-ventricular septal defect in 28 patients, absent pulmonary valve in four patients, truncus arteriosus in six patients, TGA-VSD-PS in five patients, conduit stenosis in three patients, and left venticular outflow tract obstruction requiring a Ross operation in two patients. In the postoperative short-term follow-up, 15 patients out of 48 had a high fever. Of these, 12 patients had concomitantly elevated C-reactive protein levels. There were no patients with blood culture positivity. The median postoperative length of hospital stay was 14 days (IQR = 8-21 days). The overall mortality was 4% in two patients, one died of right ventricular failure and multiple organ failure and one died of pulmonary embolism. The two patients who died were not among the 15 patients with fever. However, four patients with fever underwent balloon angioplasty for conduit restenosis in their medium-term follow-up. CONCLUSION There was a high incidence of fever and adverse outcomes in the short-term postoperative follow-up of patients in whom the BioIntegral pulmonic valved conduit was implanted. Caution is advisable in using these conduits until there is convincing evidence about the sterilization and storage standards of these grafts.
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Affiliation(s)
- Arif Selcuk
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yigit Kilic
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Oktay Korun
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Okan Yurdakok
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Cicek
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Husnu F Altin
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Altuntas
- Department of Anesthesiology and Reanimation, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Emine H Yilmaz
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Sasmazel
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan A Aydemir
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Shaker R, Arabi M, Khafaja S, Fayad D, Casals AA, Lteif M, Shamseddine S, Taqa MA, Charafeddine F, Rassi IE, Al-Halees Z, Bitar F, Hanna-Wakim R, Dbaibo G. Placement of Labcor Pulmonary Conduit Results in a High Incidence of Postoperative Fever. World J Pediatr Congenit Heart Surg 2021; 12:55-60. [PMID: 33407033 DOI: 10.1177/2150135120956995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fever in the postoperative period in cardiac patients is common. The purpose of this study is to recognize the risk factors for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion. METHODS Patients were identified retrospectively by looking at the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code for pulmonary conduit insertion between June 2009 and December 2015 at the American University of Beirut Medical Center. Data about preoperative, perioperative, and postoperative variables were collected. Data entry and analysis were performed using SPSS version 22. RESULTS The study identified 59 patients. The most common type of pulmonary conduit used was the Contegra type (57.6%) (n = 34), followed by the Labcor type (20.3%; n = 12). Postoperative fever occurred in 61% of patients (n = 36). Fourteen patients (38.8%) had a prolonged fever that lasted for more than seven days. Prolonged postoperative fever was significantly associated with the Labcor pulmonary conduit (P value < .001) and a longer duration of pacing wires (P value: .039). Significantly prolonged fever that lasted for more than 21 days occurred in five patients who all had inserted the Labcor pulmonary conduit. CONCLUSIONS The Labcor pulmonary conduit type is a risk factor for prolonged postoperative fever. The protracted use of pacing wires could be a consequence of the prolonged fever rather than a cause. In the absence of a demonstrable infectious etiology for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion, the Labcor pulmonary conduit could be the underlying cause. Alternative management of such cases may lead to decreased antibiotic use and morbidity.
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Affiliation(s)
- Rouba Shaker
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Khafaja
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Danielle Fayad
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Aia Assaf Casals
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Mireille Lteif
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Shamseddine
- Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad Abu Taqa
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatmeh Charafeddine
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Zoheir Al-Halees
- Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Surgery, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Heart Center, 37852King Faisal Specialist Hospital and Research center, Riyadh, Saudi Arabia
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Cardiology, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Children's Heart Center, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Rima Hanna-Wakim
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghassan Dbaibo
- Department of Pediatrics and Adolescent Medicine, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Division of Pediatric Infectious Diseases, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Center for Infectious Diseases Research, 66984American University of Beirut Medical Center, Beirut, Lebanon.,Department of Biochemistry and Molecular Genetics, 66984American University of Beirut Medical Center, Beirut, Lebanon
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8
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Le Bars F, Tomasi J, Belhaj Soulami R, Colas F, Anselmi A, Verhoye JP. Long-term follow-up of the Shelhigh™ superstentless bioprosthesis aortic valve and valved conduit in a monocentric experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:776-783. [PMID: 32558524 DOI: 10.23736/s0021-9509.20.11219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Shelhigh™ SuperStentless (Shelhigh, INC., Union, NJ, USA) is a stentless aortic valve bioprosthesis and aortic root valved conduit. In 2007, this device was recalled by FDA due to malfunction, and subsequently reintegrated by BioIntegral Surgical™ Few data are available over late durability of this device. We performed a long-term follow-up of Shelhigh™ devices implanted at our center. METHODS Between 2002 and 2007, 44 patients underwent aortic valve replacement with a Shelhigh™ device (40 aortic valve bioprosthesis and 4 valved conduit). We performed a clinical and echocardiographic follow-up (9.2 years±4.3). Standardized definitions of valve-related events were adopted. RESULTS At discharge, maximum and mean aortic gradients averaged 36.1±11.3 and 21.0±6.8 mmHg, respectively. The 30-days mortality was 2.3%. Over the follow-up period, 29 patients died (65.9%); 2 deaths were valve related. Overall survival at 1, 5 and 10 years was 97.7%, 85.8% and 54% respectively. At last echocardiography, average transvalvular gradients had remained globally stable in the population (33.6±12 and 20.4±10.5 mmHg). Eight (19%) structural valve deterioration (SVD) events were reported. Two (5%) non-structural valve dysfunction (NSVD) events occurred (periprosthetic leak). Two (5%) infectious endocarditis events and two (5%) valve thromboses were also deplored. Three (7%) patients required re-operation (2 due to SVD and 1 due to endocarditis). CONCLUSIONS The immediate hemodynamic performance of the Shelhigh™ aortic bioprostheses was unexpectedly suboptimal. Despite this, hemodynamic performance remained stable over time. Patients survival at follow-up was satisfactory, however, continued surveillance is necessary.
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Affiliation(s)
- Florent Le Bars
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Reda Belhaj Soulami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Fabrice Colas
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France -
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
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9
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Alonso W, Ozdemir B, Chassin-Trubert L, Ziza V, Alric P, Canaud L. Early outcomes of native and graft-related abdominal aortic infection managed with orthotopic xenopericardial grafts. J Vasc Surg 2020; 73:222-231. [PMID: 32442610 DOI: 10.1016/j.jvs.2020.04.513] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Reconstruction of infected aortic cases has shifted from extra-anatomic to in situ. This study reports the surgical strategy and early outcomes of abdominal aortic reconstruction in both native and graft-related aortic infection with in situ xenopericardial grafts. METHODS Included in the analysis are 21 consecutive patients (mean age, 69 years; 20 male) who underwent abdominal xenopericardial in situ reconstruction of native aortic infection (4) and endovascular (4) or open (13) graft aortic infection between July 2017 and September 2019. All repairs were performed on an urgent basis, but none were ruptured. All patients were followed up with clinical and biologic evaluation, ultrasound at 3 months, and computed tomography scan at 6 months and 1 year. RESULTS Technical success was 100%; 8 patients were treated with xenopericardial tubes and 13 with bifurcated grafts. Thirty-day mortality was 4.7% (one death due to pneumonia with respiratory hypoxic failure in critical care.). Six patients (28%) developed acute kidney injury, four (19%) requiring temporary dialysis; five fully recovered and one died. Four patients (19%) required a return to the operating room. After a median follow-up of 14 months (range, 1-26 months), overall mortality was 19% (n = 4). Two patients presented with recurrent sepsis after reconstruction, leading to death due to multiorgan failure. Other patients (17/21) have discontinued antibiotics with no evidence of recurrence of infection clinically, radiologically, or on blood tests. Computed tomography scans at 1 year demonstrated no stenosis or graft dilation and one asymptomatic left graft branch thrombosis. Primary patency is 95%. CONCLUSIONS In situ xenopericardial aortic reconstruction is a safe and effective management strategy for both native and graft-related abdominal aortic infection with good short-term results. The graft demonstrates appropriate resistance to infection such that reliable eradication of infection in this vascular bed is possible. Longer follow-up is required in future studies to determine the durability of the reconstruction and need for reinterventions.
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Affiliation(s)
- William Alonso
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France.
| | - Baris Ozdemir
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Lucien Chassin-Trubert
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Vicent Ziza
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Hôpital A de Villeneuve, Montpellier, France
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Sponga S, Di Mauro M, Malvindi PG, Paparella D, Murana G, Pacini D, Weltert L, De Paulis R, Cappabianca G, Beghi C, De Vincentiis C, Parolari A, Messina A, Troise G, Salsano A, Santini F, Pierri MD, Di Eusanio M, Maselli D, Actis Dato G, Centofanti P, Mancuso S, Rinaldi M, Cagnoni G, Antona C, Picichè M, Salvador L, Cugola D, Galletti L, Pozzoli A, De Bonis M, Lorusso R, Bortolotti U, Livi U. Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry. Eur J Cardiothorac Surg 2020; 58:839-846. [DOI: 10.1093/ejcts/ezaa136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/03/2020] [Accepted: 03/09/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
OBJECTIVES
Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis.
METHODS
Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 ± 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%.
RESULTS
Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30 months (1–221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9–219)]. Survival at 5 and 8 years was 75 ± 6% and 71 ± 7%, with 3 cases of endocarditis relapse.
CONCLUSIONS
Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.
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Affiliation(s)
- Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, DAME Udine Medical School, Udine, Italy
| | - Michele Di Mauro
- Cardiac Surgery, University “G. D’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Pietro G Malvindi
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Domenico Paparella
- Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Giacomo Murana
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | | | | | | - Cesare Beghi
- Cardiac Surgery, University Hospital, Varese, Italy
| | - Carlo De Vincentiis
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, Milan, Italy
| | - Alessandro Parolari
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, Milan, Italy
| | - Antonio Messina
- Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Antonio Salsano
- Cardiac Surgery, IRCCS San Martino-IST, University Hospital, Genova, Italy
| | - Francesco Santini
- Cardiac Surgery, IRCCS San Martino-IST, University Hospital, Genova, Italy
| | - Michele D Pierri
- Cardiac Surgery, Ospedali Riuniti “Umberto I-Lancisi-Salesi”, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery, Ospedali Riuniti “Umberto I-Lancisi-Salesi”, Ancona, Italy
| | | | | | | | - Samuel Mancuso
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy
| | - Giuseppe Cagnoni
- Cardiac Surgery, Sacco Hospital, University of Milan, Milan, Italy
| | - Carlo Antona
- Cardiac Surgery, Sacco Hospital, University of Milan, Milan, Italy
| | | | | | - Diego Cugola
- Cardiac Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Alberto Pozzoli
- Cardiac Surgery, Vita e Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery, Vita e Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Cardiovascular Research Institute, Maastricht, Netherlands
| | | | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, DAME Udine Medical School, Udine, Italy
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Mehdiani A, Sorokin VA, Sule J, Smiris K, Stadnik D, Lichtenberg A, Blehm A. Mid-term single-center outcomes of BioIntegral compared to Freestyle aortic conduit implantation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:512-519. [PMID: 31815376 DOI: 10.23736/s0021-9509.19.11098-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Full aortic root replacement with biological conduit has limited options. This non-randomized cohort study aims to compare mid-term clinical and hemodynamic results of the BioIntegral (BI) composite biological versus the stentless Freestyle (FS) conduits in patients undergoing full aortic root replacement. METHODS From February 2013 to July 2017, 265 patients underwent aortic root replacement at a single institution (202 BI, 65 FS). Preoperative, intraoperative and postoperative parameters, complications including stroke, myocardial infarction (MI), endocarditis and reoperation were studied. Hemodynamic performance of both conduits was analyzed by echocardiography. Target endpoints were 30-day mortality, two-year survival, two-year freedom from major adverse valve-related and cardiovascular events. RESULTS Wider BI conduits were used (BI 27±2 vs. FS 25±2 mm, P<0.0001). The BI group had shorter cardiopulmonary bypass (BI 165±67 vs. FS 200±78 min, P<0.0001) and cross-clamp (BI 102±36 vs. FS 122±40 min, P=0.001) times. Thirty-day mortality was similar in both groups. There were fewer conduit-related reoperations in the BI group (BI 0% vs. FS 3%, P=0.012) but higher postoperative atrial fibrillation (BI 31% vs. FS 17%, P=0.025). No significant differences were observed for stroke (BI 5% vs. FS 10%, P=0.947), MI (BI 3% vs. FS 4%, P=0.583), or infective endocarditis (BI 0% vs. FS 2%, P=0.077). No significant hemodynamic differences were evident on follow-up echocardiography while an improved overall survival trend was seen in the BI group (P=0.062). CONCLUSIONS FS and BI provide comparable clinical mid-term results and hemodynamic parameters. Simplified implantation technique providing shorter cardiopulmonary bypass and operation times are advantageous for BI.
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Affiliation(s)
- Arash Mehdiani
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Vitaly A Sorokin
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore - .,Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Jai Sule
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Konstantinos Smiris
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Dmytro Stadnik
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexander Blehm
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Kondov S, Beyersdorf F, Rylski B, Kreibich M, Dimov A, Berger T, Siepe M, Czerny M. Redo aortic root repair in patients with infective prosthetic endocarditis using xenopericardial solutions. Interact Cardiovasc Thorac Surg 2019; 29:339-343. [DOI: 10.1093/icvts/ivz105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/13/2019] [Accepted: 03/29/2019] [Indexed: 12/19/2022] Open
Abstract
Abstract
OBJECTIVES
We describe a conceptual approach involving the use of self-made xenopericardial grafts in combination with biological aortic valve prostheses and in addition using a xenopericardial tubes for aortic valve reimplantation in patients with infective prosthetic endocarditis after aortic root repair or supracoronary ascending aortic replacement.
METHODS
The cohort comprised 7 consecutive patients with proven prosthetic infection either after aortic root replacement (n = 5), the David operation (n = 1) or supracoronary ascending aortic replacement (n = 1). The strategy consists of complete removal of the infected prosthetic material and orthotopic reconstruction using a bovine pericardial patch sewn as a tube according to the required aortic diameter.
RESULTS
In case of valve replacement, Edwards Magna Ease (n = 4 patients) and Edwards Inspiris (n = 2 patients) were used inside the xenopericardial tube. Five patients also required hemiarch and 1 patient required complete aortic arch replacement. Median length of stay in the intensive care unit and on the regular ward thereafter was 11 (6.5–13.5) days and 26.0 (14.5–32.5) days, respectively. All patients were successfully discharged. Median follow-up time was 7.6 (±2.1) months. Currently, all patients are not on antibiotic therapy and free from any signs of persisting or recurring infection. At the short-term follow-up, no structural valve deterioration, paravalvular insufficiency or graft calcification was found.
CONCLUSIONS
Using a self-made xenopericardial graft in combination with a biological aortic valve prosthesis for a Bio-Bentall and using a xenopericardial tube for a Bio-David operation is a safe and reproducible strategy and presents an off-the-shelf alternative to homografts. The short-term results of this approach are excellent. Further studies are needed to confirm mid- and long-term durability in larger cohorts.
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Affiliation(s)
- Stoyan Kondov
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Aleksandar Dimov
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Tim Berger
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Faculty of Medicine, Department of Cardiovascular Surgery, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
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Weiss S, Tobler EL, von Tengg-Kobligk H, Makaloski V, Becker D, Carrel TP, Schmidli J, Wyss TR. Self Made Xeno-pericardial Aortic Tubes to Treat Native and Aortic Graft Infections. Eur J Vasc Endovasc Surg 2017; 54:646-652. [DOI: 10.1016/j.ejvs.2017.07.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/19/2017] [Indexed: 12/13/2022]
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Carrel T, Englberger L, Schmidli J. How to treat aortic graft infection? With a special emphasis on xeno-pericardial aortic tube grafts. Gen Thorac Cardiovasc Surg 2017; 67:44-52. [DOI: 10.1007/s11748-017-0839-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
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15
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Sadeque SAA, Salhiyyah K, Livesey S. Pseudoaneurysm formation in the Biointegral No-React® prosthesis: does it share the problems of its predecessor? Eur J Cardiothorac Surg 2017; 52:397. [PMID: 28379403 DOI: 10.1093/ejcts/ezx082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Syed Asif Arafat Sadeque
- Department of Cardiothoracic Surgery, Southampton University Hospitals NHS Trust, Southampton, Hampshire, UK
| | - Kareem Salhiyyah
- Department of Cardiothoracic Surgery, Southampton University Hospitals NHS Trust, Southampton, Hampshire, UK
| | - Steven Livesey
- Department of Cardiothoracic Surgery, Southampton University Hospitals NHS Trust, Southampton, Hampshire, UK
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16
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Holubec T, Sahin A, Emmert MY. Reply to Sadeque et al. Eur J Cardiothorac Surg 2017; 52:397-398. [PMID: 28379319 DOI: 10.1093/ejcts/ezx080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tomas Holubec
- Department of Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Ayhan Sahin
- Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Roubelakis A, Karangelis D, Sadeque S, Yanagawa B, Modi A, Barlow CW, Livesey SA, Ohri SK. Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis. Perfusion 2017; 32:383-388. [PMID: 28118782 DOI: 10.1177/0267659117690250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement. METHODS Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days). RESULTS There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre-discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis. CONCLUSIONS Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort.
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Affiliation(s)
- Apostolos Roubelakis
- 1 Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Dimos Karangelis
- 2 Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Syed Sadeque
- 1 Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Bobby Yanagawa
- 2 Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Amit Modi
- 1 Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Clifford W Barlow
- 1 Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Steven A Livesey
- 1 Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Sunil K Ohri
- 1 Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
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Carrel T, Reineke D, Englberger L. Another report on unfavourable long-term outcome following implantation of the Shelhigh No-React™ valved tube graft. Eur J Cardiothorac Surg 2016; 50:1179-1180. [PMID: 27307482 DOI: 10.1093/ejcts/ezw205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thierry Carrel
- Department of Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
| | - Lars Englberger
- Department of Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland
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Sahin A, Müggler O, Sromicki J, Caliskan E, Reser D, Emmert MY, Alkadhi H, Maisano F, Falk V, Holubec T. Long-term follow-up after aortic root replacement with the Shelhigh® biological valved conduit: a word of caution! Eur J Cardiothorac Surg 2016; 50:1172-1178. [DOI: 10.1093/ejcts/ezw167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/02/2016] [Accepted: 04/13/2016] [Indexed: 11/13/2022] Open
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