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DOI: 10.1055/s-0041-1725754
Incidence of Infective Endocarditis after AV: Neocuspidization Using Autologous Pericardium (Ozaki Procedure)
Objectives: Recently, aortic valve neocuspidization (AVNeo) using autologous pericardium was introduced and showed excellent early and midterm hemodynamic results in terms of pressure gradients and effective orifice area (EOA). Nevertheless, mid- and long-term data regarding valve durability are lacking. Recent data suggest that infective endocarditis might be the most important trigger for reoperation.
Methods: From 11/2016 to 08/2020, a total of 152 patients with a mean age of 54.5 years ± 16 years underwent AVNeo at our institution. None of these patients had presented with acute infective endocarditis at primary surgery. We analyzed hemodynamic performance and clinical outcome with a special focus on the incidence of infective endocarditis during follow-up. For hemodynamic evaluation transthoracic echo (TTE) was performed prior to the operation, at discharge and annually after surgery.
Result: Mean follow-up time was 1.8 years ± 1.1 (range from 3 days to 3.8 years) with a cumulative follow-up of 342.5 patient-years. At discharge, mean pressure gradient (MPG) was 8.5 ± 3.7 mm Hg, and remained stable at 1-, 2, and 3-year follow-up with MPG being 8.8 ± 3.9 mm Hg, 9.7 ± 4.4 mm Hg, and 9.0 ± 4.4 mm Hg, respectively. Furthermore, effective orifice area (EOA) was preserved over time with a mean EOA of 2.3 ± 0.8 cm2, 2.2 ± 0.8 cm2, 2.0 ± 0.7 cm2 at 1-, 2-, and 3 years of follow-up, respectively, and 2.1 ± 0.6 cm2 at discharge. Overall, eight patients underwent reoperation resulting in a freedom from reoperation of 94.7%. Main indication for reoperation was infective endocarditis in five of eight cases. Linearized event rate for endocarditis was 1.46% per patient year during follow-up. Potential reasons and time course of infective endocarditis are given in Table 1.
Patient no. |
Time after surgery |
Background and possible foci |
1 |
43 days |
Pericardial function before surgery |
2 |
99 days |
Long-term steroid therapy |
3 |
1.72 years |
Unclear focus |
4 |
2.34 years |
Treatment for newly diagnosed multiple myeloma |
5 |
2.82 years |
Hospitalization for carotid surgery |
Conclusion: AVNeo showed preserved excellent hemodynamic outcomes in terms of MPG and EOA. Main reason for reoperation is infective endocarditis during midterm follow-up.
Publication History
Article published online:
19 February 2021
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