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Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?

BACKGROUND: One third of patients with infective endocarditis will require operative intervention. Given the superiority of valve repair over valve replacement in many indications other than endocarditis, there has been increasing interest and an increasing number of reports of excellent results of...

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Autores principales: Myers, Patrick O, Cikirikcioglu, Mustafa, Kalangos, Afksendiyos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131057/
https://www.ncbi.nlm.nih.gov/pubmed/25087015
http://dx.doi.org/10.1186/1471-2482-14-48
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author Myers, Patrick O
Cikirikcioglu, Mustafa
Kalangos, Afksendiyos
author_facet Myers, Patrick O
Cikirikcioglu, Mustafa
Kalangos, Afksendiyos
author_sort Myers, Patrick O
collection PubMed
description BACKGROUND: One third of patients with infective endocarditis will require operative intervention. Given the superiority of valve repair over valve replacement in many indications other than endocarditis, there has been increasing interest and an increasing number of reports of excellent results of valve repair in acute infective endocarditis. The theoretically ideal material for valve repair in this setting is non-permanent, “vanishing” material, not at risk of seeding or colonization. The goal of this contribution is to review currently available data on biodegradable materials for valve repair in infective endocarditis. DISCUSSION: Rigorous electronic and manual literature searches were conducted to identify reports of biodegradable materials for valve repair in infective endocarditis. Articles were identified in electronic database searches of Medline, Embase and the Cochrane Library, using a predetermined search strategy. 49 manuscripts were included in the review. Prosthetic materials needed for valve repair can be summarized into annuloplasty rings to remodel the mitral or tricuspid annulus, and patch materials to replace resected valvar tissue. The commercially available biodegradable annuloplasty ring has shown interesting clinical results in a single-center experience; however further data is required for validation and longer follow-up. Unmodified extra-cellular matrix patches, such as small intestinal submucosa, have had promising initial experimental and clinical results in non-infected valve repair, although in valve repair for endocarditis has been reported in only one patient, and concerns have been raised regarding their mechanical stability in an infected field. SUMMARY: These evolving biodegradable devices offer the potential for valve repair with degradable materials replaced with autologous tissue, which could further improve the results of valve repair for infective endocarditis. This is an evolving field with promising experimental or initial clinical results, however long-term outcomes are lacking and further data is necessary to validate this theoretically interesting approach to infective endocarditis.
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spelling pubmed-41310572014-08-15 Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street? Myers, Patrick O Cikirikcioglu, Mustafa Kalangos, Afksendiyos BMC Surg Debate BACKGROUND: One third of patients with infective endocarditis will require operative intervention. Given the superiority of valve repair over valve replacement in many indications other than endocarditis, there has been increasing interest and an increasing number of reports of excellent results of valve repair in acute infective endocarditis. The theoretically ideal material for valve repair in this setting is non-permanent, “vanishing” material, not at risk of seeding or colonization. The goal of this contribution is to review currently available data on biodegradable materials for valve repair in infective endocarditis. DISCUSSION: Rigorous electronic and manual literature searches were conducted to identify reports of biodegradable materials for valve repair in infective endocarditis. Articles were identified in electronic database searches of Medline, Embase and the Cochrane Library, using a predetermined search strategy. 49 manuscripts were included in the review. Prosthetic materials needed for valve repair can be summarized into annuloplasty rings to remodel the mitral or tricuspid annulus, and patch materials to replace resected valvar tissue. The commercially available biodegradable annuloplasty ring has shown interesting clinical results in a single-center experience; however further data is required for validation and longer follow-up. Unmodified extra-cellular matrix patches, such as small intestinal submucosa, have had promising initial experimental and clinical results in non-infected valve repair, although in valve repair for endocarditis has been reported in only one patient, and concerns have been raised regarding their mechanical stability in an infected field. SUMMARY: These evolving biodegradable devices offer the potential for valve repair with degradable materials replaced with autologous tissue, which could further improve the results of valve repair for infective endocarditis. This is an evolving field with promising experimental or initial clinical results, however long-term outcomes are lacking and further data is necessary to validate this theoretically interesting approach to infective endocarditis. BioMed Central 2014-08-03 /pmc/articles/PMC4131057/ /pubmed/25087015 http://dx.doi.org/10.1186/1471-2482-14-48 Text en Copyright © 2014 Myers et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Debate
Myers, Patrick O
Cikirikcioglu, Mustafa
Kalangos, Afksendiyos
Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?
title Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?
title_full Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?
title_fullStr Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?
title_full_unstemmed Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?
title_short Biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?
title_sort biodegradable materials for surgical management of infective endocarditis: new solution or a dead end street?
topic Debate
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4131057/
https://www.ncbi.nlm.nih.gov/pubmed/25087015
http://dx.doi.org/10.1186/1471-2482-14-48
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