Clinical results of the Shelhigh® stentless bioprosthesis in patients with active infective endocarditis:

8-year single center experience
  • Michele Musci
  • Y. Weng
  • Henryk Siniawski
  • S. Kosky
  • M. Pasic
  • M. Hübler
  • A. Amiri
  • J. Stein
  • R. Meyer
  • Roland Hetzer


Despite improvements in medical care, the incidence of left-sided active infective endocarditis (AIE) has remained unchanged over the past few decades. As shown in a review of 26 publications on a total of almost 3800 patients treated between 1993 and 2003, it is reported to affect a median of 3.6–5.4/100 000 persons per year, increasing in individuals over 65 years old to 15.0/100 000 persons per year, with a male:female ratio of 2:1 [1]. This unchanging incidence may be explained by changes in both the spectrum of causative organisms and in the patients affected [2]. New groups at risk of endocarditis have emerged, for example, the increasingly aging population with heart valve sclerosis, patients with prosthetic valves, those exposed to nosocomial infections, hemodialysis patients, and intravenous drug abusers [3], while chronic rheumatic fever, which was a classic predisposing factor in the preantibiotics era, has become rare in industrialized countries. These developments reflect our experience of continuing high numbers of patients who have to be operated on for AIE each year: between May 1986 and December 2008 a total of 1313 AIE patients were operated on at the Deutsches Herzzentrum Berlin, 72.4% (n=1009) for native endocarditis and 27.6% (n=384) for prosthetic endocarditis (Fig. 1).
Fig. 1.

Operations for native and prosthetic active infective endocarditis at the Deutsches Herzzentrum Berlin from May 1986 to December 2008


Infective Endocarditis Mitral Valve Replacement Double Valve Replacement Stentless Bioprosthesis Native Valve Infective Endocarditis 


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  1. 1.
    Moreillon P, Que YA (2004) Infective endocarditis. Lancet 363:139–149CrossRefPubMedGoogle Scholar
  2. 2.
    Hoen B, Alla F, Selton-Suty C, Beguinot I, Bouvet A, Briancon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Le Moing V, Leport C, Mainardi JL, Ruimy R, Vandenesch F (2002) Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 288:75–81.CrossRefPubMedGoogle Scholar
  3. 3.
    Cabell CH, Abrutyn E, Fowler VG, Jr., Hoen B, Miro JM, Corey GR, Olaison L, Pappas P, Anstrom KJ, Stafford JA, Eykyn S, Habib G, Mestres CA, Wang A (2005) Use of surgery in patients with native valve infective endocarditis: results from the International Collaboration on Endocarditis Merged Database. Am Heart J 150:1092–1098CrossRefPubMedGoogle Scholar
  4. 4.
    Musci M, Siniawski H, Knosalla C, Grauhan O, Weng Y, Pasic M, Meyer R, Hetzer R (2006) Early and mid-term results of the Shelhigh stentless bioprosthesis in patients with active infective endocarditis. Clin Res Cardiol 95:247–253CrossRefPubMedGoogle Scholar
  5. 5.
    Siniawski H, Lehmkuhl H, Weng Y, Pasic M, Yankah C, Hoffmann M, Behnke I, Hetzer R (2003) Stentless aortic valves as an alternative to homografts for valve replacement in active infective endocarditis complicated by ring abscess. Ann Thorac Surg 75:803–808, discussion 808CrossRefPubMedGoogle Scholar
  6. 6.
    Abolhoda A, Yu S, Oyarzun JR, Allen KR, McCormick JR, Han S, Kemp FW, Bogden JD, Lu Q, Gabbay S (1996) No-react detoxification process: a superior anticalcification method for bioprostheses. Calcification of bovine pericardium: glutaraldehyde versus No-React biomodification. Ann Thorac Surg 62:1724–1730CrossRefPubMedGoogle Scholar
  7. 7.
    Abolhoda A, Yu S, Oyarzun JR, McCormick JR, Bogden JD, Gabbay S (1996) Calcification of bovine pericardium: glutaraldehyde versus No-React biomodification. Ann Thorac Surg 62:169–174CrossRefPubMedGoogle Scholar
  8. 8.
    Alexiou C, Langley SM, Stafford H, Lowes JA, Livesey SA, Monro JL (2000) Surgery for active culture-positive endocarditis: determinants of early and late outcome. Ann Thorac Surg 69:1448–1454CrossRefPubMedGoogle Scholar
  9. 9.
    Reinhartz O, Herrmann M, Redling F, Zerkowski HR (1996) Timing of surgery in patients with acute infective endocarditis. J Cardiovasc Surg (Torino) 37:397–400Google Scholar
  10. 10.
    Akar AR, Szafranek A, Alexiou C, Janas R, Jasinski MJ, Swanevelder J, Sosnowski AW (2002) Use of stentless xenografts in the aortic position: determinants of early and late outcome. Ann Thorac Surg 74:1450–1457, discussion 1457–1458CrossRefPubMedGoogle Scholar
  11. 11.
    Tornos P, Iung B, Permanyer-Miralda G, Baron G, Delahaye F, Gohlke-Barwolf C, Butchart EG, Ravaud P, Vahanian A (2005) Infective endocarditis in Europe: lessons from the Euro heart survey. Heart 91:571–575CrossRefPubMedGoogle Scholar
  12. 12.
    Horstkotte D, Follath F, Gutschik E, Lengyel M, Oto A, Pavie A, Soler-Soler J, Thiene G, von Graevenitz A, Priori SG, Garcia MA, Blanc JJ, Budaj A, Cowie M, Dean V, Deckers J, Fernandez Burgos E, Lekakis J, Lindahl B, Mazzotta G, Morais J, Smiseth OA, Vahanian A, Delahaye F, Parkhomenko A, Filipatos G, Aldershvile J, Vardas P (2004) Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the task force on infective endocarditis of the European society of cardiology. Eur Heart J 25:267–276CrossRefPubMedGoogle Scholar
  13. 13.
    Aksoy O, Sexton DJ, Wang A, Pappas PA, Kourany W, Chu V, Foler VG Jr, Woods CW, Engemann JJ, Corey GR, Harding T, Cabell CH (2007) Early surgery in patients with infective endocarditis: a propensity score analysis. Clin Infect Dis 44:364–372CrossRefPubMedGoogle Scholar
  14. 14.
    Vikram HR, Buenconsejo J, Hasbun R, Quagliarello VJ (2003) Impact of valve surgery on 6-month mortality in adults with complicated, left-sided native valve endocarditis: a propensity analysis. Jama 290:3207–3214CrossRefPubMedGoogle Scholar
  15. 15.
    Choussat R, Thomas D, Isnard R, Michel PL, Iung B, Hanania G, Mathieu P, David M, du Roy de Chaumaray T, De Gevigney G, Le Breton H, Logeais Y, Pierre-Justin E, de Riberolles C, Morvan Y, Bischoff N (1999) Perivalvular abscesses associated with endocarditis; clinical features and prognostic factors of overall survival in a series of 233 cases. Perivalvular Abscesses French Multicentre Study. Eur Heart J 20:232–241CrossRefPubMedGoogle Scholar
  16. 16.
    Fowler VG, Jr., Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, Corey GR, Spelman D, Bradley SF, Barsic B, Pappas PA, Anstrom KJ, Wray D, Fortes CQ, Anguera I, Athan E, Jones P, van der Meer JT, Elliott TS, Levine DP, Bayer AS (2005) Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 293:3012–3021CrossRefPubMedGoogle Scholar
  17. 17.
    Anguera I, Miro JM, Cabell CH, Abrutyn E, Fowler VG Jr, Hoen B, Olaison L, Pappas PA, de Lazzari E, Eykyn S, Habib G, Pare C, Wang A, Corey R (2005) Clinical characteristics and outcome of aortic endocarditis with periannular abscess in the International Collaboration on Endocarditis Merged Database. Am J Cardiol 96:976–981CrossRefPubMedGoogle Scholar
  18. 18.
    Hill EE, Vanderschueren S, Verhaegen J, Herijgers P, Claus P, Herregods MC, Peetermans WE (2007) Risk factors for infective endocarditis and outcome of patients with Staphylococcus aureus bacteremia. Mayo Clin Proc 82:1165–1169CrossRefPubMedGoogle Scholar
  19. 19.
    Yankah AC, Pasic M, Klose H, Siniawski H, Weng Y, Hetzer R (2005) Homograft reconstruction of the aortic root for endocarditis with periannular abscess: a 17-year study. Eur J Cardiothorac Surg 28:69–75. Epub 2005 Apr 18CrossRefPubMedGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Michele Musci
    • 1
  • Y. Weng
  • Henryk Siniawski
    • 2
  • S. Kosky
  • M. Pasic
  • M. Hübler
  • A. Amiri
  • J. Stein
  • R. Meyer
  • Roland Hetzer
    • 3
  1. 1.Abt. für Herz-, Thorax-und GefäßchirurgieDeutsches Herzzentrum BerlinBerlinGermany
  2. 2.Charité Medical University BerlinDeutsches Herzzentrum BerlinBerlinGermany
  3. 3.Deutsches Herzzentrum BerlinBerlinGermany

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