Homograft Versus Valves and Valved Conduits for Extensive Aortic Valve Endocarditis with Aortic Root Involvement/Destruction: A Systematic Review and Meta-Analysis

AORTA

article

Michael L. Williams¹  John D. L. Brookes¹  Joseph S. Jaya²  Eren Tan³ 

[1] Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital;Department of Surgery, Monash Health;Department of Surgery, Eastern Health

关键词: endocarditis;    aortic valve;    homograft;    aortic root abscess;   

DOI  :  10.1055/s-0042-1743110

来源: Thieme

【 摘 要 】

Aortic valve infective endocarditis is a life-threatening condition. Patients frequently present profoundly unwell and extensive surgery may be required to correct the underlying anatomical deficits and control sepsis. Periannular involvement occurs in more than 10% of patients with aortic valve endocarditis. Complex aortic valve endocarditis has a mortality rate of 10 to 40%. Longstanding surgical dogma suggests homografts represent the optimal replacement option in complex aortic valve endocarditis; however, there is a paucity of evidence and lack of consensus on the optimal replacement choice. A systematic review and meta-analysis was performed utilizing EMBASE, PubMed, and the Cochrane databases to review articles describing homografts versus aortic valve replacement and/or valved conduit graft implantation for complex aortic valve endocarditis. The outcomes of interest were mortality, reinfection, and reoperation. Eleven studies were included in this meta-analysis, contributing 810 episodes of complex aortic valve endocarditis. All included reports were cohort studies. There was no statistically significant difference in overall mortality (risk ratio [RR] 0.99; 95% confidence interval [CI], 0.61–1.59; p = 0.95), reinfection (RR 0.89; 95% CI, 0.45–1.78; p = 0.74), or reoperation (RR 0.91; 95% CI, 0.38–2.14; p = 0.87) between the homograft and valve replacement/valved conduit graft groups. Overall, there was no difference in mortality, reinfection, or reoperation rates between homografts and other valve or valved conduits in management of complex aortic endocarditis. However, there is a paucity of high-quality evidence in the area, and comparison of valve types warrants further investigation.

【 授权许可】

Unknown