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Prosthetic valve sewing-ring sealing with antibiotic and fibrin glue in infective endocarditis. A prospective clinical study

^a Department of Cardiovascular Surgery B, Claude Bernard University, INSERM E226, Louis Pradel Hospital, 28, avenue du doyen Lepine, 69677 Bron Cedex, France
^b Department of Cardiology, Louis Pradel Hospital, Claude Bernard University, UMR MA103, Bron, France

*Corresponding author. Tel.: +33 4 72 35 75 29; fax: +33 4 72 35 75 32.

E-mail address: fadi.farhat{at}chu-lyon.fr (F. Farhat).

To analyze the benefits of prosthetic valve sewing ring sealing with antibiotic and fibrin glue in endocarditis, a prospective study was undertaken in 16 consecutive patients. Valvular lesions concerned aortic valve in seven patients, mitral valve in three and both in six. Preoperative antibiotic treatment was started 15±15 days before surgery. Peroperative findings showed six isolated valvular lesions and ten perivalvular extensions. Before the prostheses were sutured to the annulus, the Dacron^TM sewing rings were covered with antibiotic and fibrin glue. The antibiotic was chosen according to the micro-organism identified preoperatively. We didn't have any peroperative mortality or paravalvular leakage (PVL). One patient died suddenly on postoperative day (POD) nine (non-contributive autopsy). Another patient was reoperated on POD 31 for PVL. Peroperative local bacteriological examinations were sterile. Mean follow-up was of 9.3±6.8 months and was completed in all cases. Actuarial survival rate was 94±6% and freedom from reoperation was 92±7%. Antibiotic treatment was stopped after 59±64 days for 10 patients. None of them had recurrence of endocarditis or PVL. Prosthetic valve sewing ring sealing with adapted antibiotic and fibrin glue can constitute a good weapon in the armamentarium of surgical treatment of active endocarditis.

Key Words: Endocarditis; Antibiotic/fibrin glue sealant; Parvalvular abscess; Prosthesis infection