Abstract
Objective
Intrinsic risk of infection of cryopreserved allograft aortic root replacements remains
poorly understood despite their long history of use. The objective of this study was
to determine this intrinsic risk of allograft infection and its risk factors when
allografts are implanted for both nonendocarditis indications and infective endocarditis.
Methods
From January 1987 to January 2017, 2042 patients received 2110 allograft aortic valves
at a quaternary medical center, 1124 (53%) for nonendocarditis indications and 986
(47%) for endocarditis indications (670 [68%] prosthetic valve endocarditis). Staphylococcus aureus caused 193 of 949 cases of endocarditis (20%), 71 (7.3%) in persons who injected
drugs. Periodic surveillance and cross-sectional follow-up achieved 85% of possible
follow-up time. The primary end point was allograft infection in patients with nonendocarditis
and endocarditis indications. Risk factors were identified by hazard function decomposition
and machine learning.
Results
During follow-up, 30 allografts (26 explanted) became infected in patients in the
nonendocarditis group and 49 (41 explanted) in patients with endocarditis. At 20 years,
the probability of allograft infection was 5.6% in patients in the nonendocarditis
group and 14% in patients with endocarditis. Risk factors for allograft infection
in patients in the nonendocarditis group were younger patient age and older donor
age. Risk factors for allograft infection in patients with endocarditis were earlier
implant year, injection drug use, and younger age. In patients with endocarditis,
18% of allograft infections were caused by the original organism.
Conclusions
The low infection rates, both in patients without and with endocarditis, support continued
use of allografts in the modern era, in particular for the treatment of invasive endocarditis
of the aortic root.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: May 11, 2021
Accepted:
April 21,
2021
Received in revised form:
April 14,
2021
Received:
June 30,
2020
Footnotes
This study was sponsored by CryoLife, Inc, which had no role in the collection, analysis, or interpretation of the data, and no right to approve or disapprove publication of the finished manuscript.
Institutional Review Board 4826 and 17-285; initial approval date: March 31, 2017. Use of these data for research was approved by the Institutional Review Board, with patient consent waived.
Identification
Copyright
© 2021 by The American Association for Thoracic Surgery
ScienceDirect
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