Early and mid–term results of the Shelhigh stentless bioprosthesis in patients with active infective endocarditis |
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Authors: | Dr Michele Musci MD H Siniawski MD PhD C Knosalla MD PhD O Grauhan MD PhD Y Weng MD PhD M Pasic MD PhD R Meyer MD PhD R Hetzer MD PhD |
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Institution: | 1. Deutsches Herzzentrum Berlin, Abt. für Herz-, Thorax und
Gef??chirurgie, Augustenburger Platz 1, 13353, Berlin, Germany 2. Deutsches Herzzentrum Berlin, Department for Cardiac Pathology, Augustenburger Platz 1, 13353, Berlin, Germany
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Abstract: | Summary
Aims This study investigated the early and mid–term results following valve replacement with the new Shelhigh? stentless bioprosthesis made entirely of biological material in patients with active infective endocarditis (AIE).
Material and methods Between 02/2000 and 12/2004, 164 patients (n = 122 men, mean age 59, 18–85 years) received implantation of an AIE Shelhigh? stentless bioprosthesis in the aortic, mitral, tricuspid or pulmonary position. A total of 119 patients (72.6%) had native
AIE and 45 (27.4%) prosthetic AIE. A large proportion of the patients reached the operating room in a condition of cardiac
decompensation: 37 (22.6%) patients were intubated, 40 (24.4%) had protracted septic shock and 41 (25.0%) required intensive
catecholamine treatment. Surgery was regarded as urgent in 94 patients (57.4%) and was performed as an emergency procedure
in 70 (42.6%). The mean follow–up time is 1.5 ± 0.11 years (range, 5 months to 5.2 years). Echocardiographic follow–up examinations
were performed early postoperatively and after 12 months.
Results In terms of the operative indication, we found a highly significant difference in the survival rate between patients who were
operated on urgently vs in an emergency. In patients who died within 30 days, the main cause of death was septic multiorgan
failure (67.6%). Only three patients required reoperation due to reinfection of the Shelhigh? bioprostheses; this represents a reinfection rate of 1.8% in relation to the whole cohort. The postoperative echocardiographic
examinations showed the Shelhigh? valves to have very good hemodynamics without relevant pressure gradients.
Conclusion Our experience in the use of Shelhigh? bioprostheses in patients with native and prosthetic endocarditis show the early and mid–term results, in particular the
low reinfection rate and the good hemodynamics, to be comparable with the results achieved using homografts. Since these prostheses
are readily available and their implantation straightforward, they are increasingly being used in patients with endocarditis.
These promising results need to verified in the long term.
This paper was presented at a lecture held at the 71st annual meeting of the German Society for Cardiology, Mannheim, 31. March—2. April 2005.
Disclosure Form: The following study discloses my relationship with any corporate sponsor that might relate in some way to
the subject presented. |
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Keywords: | Endocarditis bioprosthesis surgery |
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