Three Decades of Experience with Aortic Prosthetic Valve Endocarditis

The objective of this study was to evaluate early and long-term outcomes of patients with aortic prosthetic valve endocarditis (a-PVE) treated with a prosthetic aortic valve (PAV), prosthetic valved conduit (PVC), or cryopreserved aortic homograft (CAH). A total of 144 patients, 115 male and 29 female, aged 67 +/- 12 years, underwent surgery for a-PVE at our institution between 1994 and 2021. Median time from the original cardiac surgery was 1.9 [0.6-5.6] years, and 47 (33%) patients developed an early a-PVE. Of these patients, 73 (51%) underwent aortic valve replacement (AVR) with a biological or mechanical PAV, 12 (8%) underwent aortic root replacement (ARR) with a biological or mechanical PVC, and 59 (42%) underwent AVR or ARR with a CAH. Patients treated with a CAH had significantly more circumferential annular abscess multiple valve involvement, longer CPB and aortic cross-clamping times, and needed more postoperative pacemaker implantation than patients treated with a PAV. No difference was observed in survival, reoperation rates, or recurrence of IE between patients treated with a PAV, a PVC, or a CAH. CAHs are technically more demanding and more often used in patients who have extensive annular abscess and multiple valve involvement. However, the use of CAH is safe in patients with complex a-PVE, and it shows excellent early and long-term outcomes

Evaluation of allograft contamination and decontamination at the Treviso Tissue Bank Foundation: A retrospective study of 11,129 tissues.

Microbiological contamination of retrieved tissues has become a very important topic and a critical aspect in the safety of allografts. We have analysed contamination in 11,129 tissues with a longitudinal contamination profile for each individual tissue. More specifically, 10,035 musculoskeletal tissues and 1,094 cardiovascular tissues were retrieved from a total of 763 multi-tissue donors, of whom 105 were heart-beating donors as well as organ donors, while the remaining 658 were non-heart beating donors and tissue donors only. All tissues were decontaminated twice, the first time immediately after retrieval and the second time after processing. Each tissue was submitted to microbiological culture three times, i.e., upon retrieval (Time 1), after the first decontamination (Time 2) and after the second decontamination (Time 3). The contamination rate for musculoskeletal tissues was 52%, 16.2% and 0.5% at Time 1, 2 and 3, respectively. The contamination rate for cardiovascular tissues was 84%, 42% and 6%. More than one strain was simultaneously present in 10.8% of musculoskeletal tissues and 44.6% of cardiovascular tissues. Out of 8,560 non-heart-beating donor musculoskeletal tissues, 4,689 (54.8%), 1,383 (16.2%) and 42 (0.5%) were contaminated at Time 1, Time 2 and Time 3, respectively. Out of 1,475 heart-beating donor musculoskeletal tissues, 522 (35.4%) 113 (7.7%) and 2 (0.1%) tissues were found to be contaminated at Time 1, 2 and 3, respectively. Out of 984 non-heart beating donor cardiovascular tissues, 869 (88.3%), 449 (45.6%) and 69 (7%) proved positive at Time 1, 2 and 3 respectively, while 50 (45.5%) and 10 (9.1%) heart-beating donor cardiovascular tissues were contaminated at Time 1 and 2. No tissue was contaminated at Time 3. Based on our methods, the two-step decontamination approach is mandatory in order to drastically reduce the number of tissues found to be positive at the end of the process

Bilaminar Technique with Coronally Advanced Flap and Cryopreserved Human Amniotic Membrane in the Treatment of Gingival Recessions

Gingival recessions are usually treated with surgical therapies which involve the use of connective tissue autograft in order to thicken the gingival tissue. This has an important biological repercussion on patients since they will have surgical wounds in two different oral cavity sites. In this case report, we offer an alternative technique for the treatment of a Miller class I gingival recession. A 40-year-old female patient has been treated with a combination of bilaminar and coronally advance flap techniques to cover a Miller class I gingival recession with addition of cryopreserved human amniotic membrane. The human amniotic membrane has been employed to thicken the keratinized tissue. The human amniotic membrane in combination with bilaminar and coronally advance flap techniques has produced aesthetically and functionally satisfying results, covering completely the gingival recession and restoring the natural colour and thickness of the gingiva. Bilaminar technique with coronally advanced flap and cryopreserved human amniotic membrane is a valid alternative in treating Miller class I and II gingival recessions and reduce the biological morbidity of a double intervention

Human amniotic membrane in the treatment of MRONJ

PurposeHuman amniotic membrane (HAM) has biological properties which are important for the experimental and clinical applications in managing patients of various medical specialties such as oral and maxilla-facial surgery.The aim was to evaluate the use of HAM as improvement in surgical wound healing and reduction of relapse in patient affected by medication-related osteonecrosis of the jaw (MRONJ). Materials and MethodsA prospective cohort of patients with the diagnosis of MRONJ at the unit of Maxillofacial Surgery of the Ca Foncello Hospital in Treviso, Italy was selected for the study from October 2016 and May 2019. The patients underwent surgical treatment with the placement of amniotic membrane patches. Staging of the lesions was performed according to classification of MRONJ set by the Italian Society of oral medicine with Italian Society of maxillofacial surgery. A multivariate logistic regression was conducted to evaluate the effects of surgical therapy on disease resolution.Results27 patients were included in this study (a total of 34 surgical sites) with a mean age of 68.48 years. The sample involved 6 male and 21 female. 16 patients were assuming Zoledronic acid. Antiresorptive/Antiangiogenic agents were being taken by 16 oncological patients (57%). The median follow-up period was 14,39 months.Only 2 patients after 30 days since they were surgically treated showed persistent bone exposure. Both patients were retreated with success. ConclusionsThe use of the amniotic membrane has a learning curve that is fast enough to justify its routine use, in order to improve the predictability of the interventions for the management of MRONJ. In particular, implement the patient's quality of life and reduce the risk of relapse. The work stands as a pilot study in order to further enhance the results obtained, also introducing a control group

Human amniotic membrane: an improvement in the treatment of Medication-related osteonecrosis of the jaw (MRONJ)? A case\u2013control study

The aim of this article is to report the results obtained by the use of HAM in surgical wound healing and the reduction of relapse in patients affected by Medication-related osteonecrosis of the jaw (MRONJ).The study involved patients with the diagnosis of MRONJ, surgically treated between October 2016 and April 2019, in a case-control setting. Enrolled patients were randomly divided into 2 groups. One group will be treated with resective surgery and with the insertion of HAM patch (Group A), while the second group had been treated exclusively with resective surgery (Group B).The patients underwent MRONJ surgical treatment with the placement of amniotic membrane patches at the wound site. Data regarding the long-term complications/functions were evaluated at 3, 6, 12, and 24months after surgery. Pain measurements were performed before the intervention (T0), 7(T1) and 30(T2) days after surgery. 49 patients were included in the study. 2 patients of GROUP A after 30days since they were surgically treated showed persistent bone exposure. 5 patients of group B demonstrated a lack of healing of the surgical wound with the persistence of bone exposed to 30days after surgery. Statistical analysis ruled out any difference in OUTCOME (relapse) between GROUP A and B (p=0.23). However, the Fisher test highlighted a significant difference between the use of HAM and only surgical treatment in pain at rest (p=0.032). The use of amniotic membrane implement the patient's quality of life and reduce pain perception. has a learning curve that is fast enough to justify its routine use

No. of tissues contaminated in Groups A and B at the two time points.

<p>No. of tissues contaminated in Groups A and B at the two time points.</p

Tissue data.

<p>Tissue data.</p

Cryopreserved aortic homografts for complex aortic valve or root endocarditis: a 28-year experience.

Objectives: The aim of this study was to evaluate early- and long-term outcomes of cryopreserved aortic homograft (CAH) implantation for aortic valve replacement (AVR) or aortic root replacement (ARR) in patients with or without complex infective endocarditis. Methods: All adult patients undergoing AVR or ARR with CAH at our institution between January 1993 and July 2021 were included in the study. Results: One hundred four patients, 75 males and 29 females, aged 59 ± 17 years, underwent AVR or ARR with CAH for infective endocarditis (n = 94, 90%) or aortic valve disease (n = 10, 10%). There were 33 (35%) native valve endocarditis and 61 (65%) prosthetic valve endocarditis, which were complicated by annular abscess in 77 (82%) patients, mitral valve endocarditis in 13 (14%) and tricuspid valve endocarditis in 13 (14%). The mean cardiopulmonary bypass time was 214 ± 80 min and the mean aortic cross-clamping time was 164 ± 56 min. There were 12 (12%) hospital deaths and 7 (7%) postoperative low cardiac output syndrome requiring extracorporeal membrane oxygenation in 4 patients and intra-aortic balloon pump in 3. Thirty-nine (42%) patients died during the follow-up (94% complete). The mean survival time was 13.9 ± 1.2 years. Twenty-five patients (26%) underwent late reoperation for aortic homograft degeneration (n = 17, 18%), homograft endocarditis (n = 6, 7%), homograft dehiscence (n = 1, 1%) and mitral valve regurgitation (n = 1, 1%). The mean survival free from reintervention was 15.7 ± 1.2 years. Conclusions: AVR or ARR with a CAH for complex endocarditis is associated with satisfactory hospital survival, considering the critical patient presentation at surgery, and excellent survival free from recurrent infection. Need for reoperation late after surgery is similar to other biological prostheses

Species isolated at Time 1 and Time 2 for CVT in both groups.

<p>Species isolated at Time 1 and Time 2 for CVT in both groups.</p