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J Thorac Cardiovasc Surg 1997;114:145-146
© 1997 Mosby, Inc.

LETTERS TO THE EDITOR

Impregnation of sewing ring with antibiotics to avoid prosthetic valve endocarditis

Department of Cardiac Surgery
The Prince Charles Hospital
Brisbane 4032, Australia

Reply to the Editor:

The authors of this letter have described a method of passively soaking all heart valves in a variety of solutions containing antibiotics before valve implantation. They have achieved a low incidence of early endocarditis in follow-up, which they recognize was incomplete.

Although we agree that early postoperative endocarditis is due to perioperative or intraoperative contamination of the valve, our results failed to demonstrate rifampicin retention in vivo when we passively soaked the unsealed sewing ring. This is also implied in the article by Karck and associates, ¹ who used a gentamicin derivative. We believe, with others, that rifampicin will bind to a protein sealant incorporated into the Dacron sewing ring, and in our study we found the best retention occurred when the sewing ring material was first sealed by being autoclaved in blood before being passively soaked in a solution of rifampicin. To do this adds significantly to the crossclamp time. We proposed a protocol of using the technique for established cases of endocarditis, in which the incidence of prosthetic valve endocarditis is highest.

It is logical to consider the concept of impregnating all valves with antibiotics to minimize prosthetic valve endocarditis caused by perioperative contamination. We suggest that to minimize crossclamp time but to provide adequate short-term local antibiotic levels in the valve sewing ring, a commercially available valve with a protein-sealed sewing ring could be soaked with rifampicin, similar to established techniques used in vascular surgery. ^{2, 3}

References

1. Karck M, Siclari F, Wahlig H, Sperling U, Schmid C, Haverich A. Pretreatment of prosthetic valve sewing ring with antibiotic fibrin sealant compound as a prophylactic tool against prosthetic valve endocarditis. Eur J Cardiothorac Surg 1990;4:142-6.[Abstract]
   
2. Strachan CJL, Newsom SWB, Ashton TR. The clinical use of an antibiotic-bonded graft. Eur J Vasc Surg 1991;5:627-32.[Medline]
   
3. Avramovic J, Fletcher JP. Prevention of prosthetic vascular graft infection by rifampicin impregnation of a protein sealed Dacron graft in combination with parenteral cephalosporin. J Cardiovasc Surg 1992;33:70-4.[Medline]
   

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by French, B. G. Articles by O'Brien, M. F. Search for Related Content PubMed Articles by French, B. G. Articles by O'Brien, M. F.