A Literature Review on the Use of Aortic Allografts in Modern Cardiac Surgery for the Treatment of Infective Endocarditis: Is There Clear Evidence or Is It Merely a Perception?
Francesco NappiThibaut SchoellCristiano SpadaccioChristophe AcarFrancisco Diniz Affonso da CostaPublished in: Life (Basel, Switzerland) (2023)
Infective valve endocarditis is caused by different pathogens and 60% of those involve the aortic valve with valve failure. Although S. aureus is recognized as the most frequently isolated causative bacterium associated with IE in high-income countries, Gram-positive cocci nevertheless play a crucial role in promoting infection in relation to their adhesive matrix molecules. The presence of pili on the surface of Gram-positive bacteria such as in different strains of Enterococcus faecalis and Streptococcus spp., grants these causative pathogens a great offensive capacity due to the formation of biofilms and resistance to antibiotics. The indications and timing of surgery in endocarditis are debated as well as the choice of the ideal valve substitute to replace the diseased valve(s) when repair is not possible. We reviewed the literature and elaborated a systematic approach to endocarditis management based on clinical, microbiological, and anatomopathological variables known to affect postoperative outcomes with the aim to stratify the patients and orient decision making. From this review emerges significant findings on the risk of infection in the allograft used in patients with endocarditis and no endocarditis etiology suggesting that the use of allografts has proved safety and effectiveness in patients with both pathologies.
Keyphrases
- aortic valve
- gram negative
- transcatheter aortic valve replacement
- aortic stenosis
- transcatheter aortic valve implantation
- aortic valve replacement
- cardiac surgery
- decision making
- ejection fraction
- end stage renal disease
- systematic review
- multidrug resistant
- minimally invasive
- acute kidney injury
- chronic kidney disease
- newly diagnosed
- candida albicans
- randomized controlled trial
- patients undergoing
- escherichia coli
- peritoneal dialysis
- case report
- prognostic factors
- mental health
- type diabetes
- patient reported outcomes
- metabolic syndrome
- percutaneous coronary intervention
- combination therapy
- cystic fibrosis
- pseudomonas aeruginosa
- atrial fibrillation
- coronary artery bypass
- smoking cessation