ARTICOLI ORIGINALI   

Chirurgia 2014 December;27(6):327-32

Copyright © 2014 EDIZIONI MINERVA MEDICA

lingua: Inglese

Recurrent endocarditis after aortic root replacement in intravenous drug users

Hillerson D. B. ¹, Raizada V. ², Dietl C. A. ³

¹ School of Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; ² Division of Cardiology, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; ³ Division of Cardiothoracic Surgery, Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

AIM: Aortic root abscess is a life-threatening complication of infective endocarditis that usually requires complete replacement of the aortic root. Previous reports suggest that recurrent endocarditis is less likely to occur if a homograft is used. However, the risk of recurrent endocarditis in intravenous drug users (IVDU) has not been addressed. The aim of this study is to determine the risk of recurrent endocarditis and late mortality after using a homograft for aortic root replacement in IVDU.
METHODS: The records of 10 patients, all known IVDU, who underwent aortic root replacement between January 2001 and December 2010, were retrospectively reviewed. Seven patients had undergone prior aortic valve replacement. Aortic root replacement was performed using a cryopreserved aortic homograft in 9 patients, and a Freestyle stentless bioprosthesis in 1 case.
RESULTS: There was no 30-day mortality. During a mean follow-up of 43.9 months (range 12-96 months), 3 patients who continued to use intravenous drugs developed recurrent endocarditis, requiring a reoperation 4 to 12 months postoperatively (mean 7.66 months), all of whom died (30% late mortality) with recurrent endocarditis 12 to 18 months (mean 15 months) after the initial aortic homograft. The remaining 7 patients were alive 30 to 96 months postoperatively (mean 56.28 months).
CONCLUSION: Aortic root replacement with homograft in intravenous drug users is a safe and effective operation. However, continued use of intravenous drugs is associated with poor prognosis because the risk of recurrent endocarditis is not eliminated.