Pretreatment of prosthetic valve sewing-ring with the antibiotic/fibrin sealant compound as a prophylactic tool against prosthetic valve endocarditis

Abstract

Prosthetic valve endocarditis (PVE) remains a dreaded complicationfollowing heart valve replacement despite perioperative antibiotic (AB)prophylaxis. In order to increase the AB concentration in the sewing ring, an experimental study including topical application of the gentamicinderivative EMD 46/217 and fibrin sealant (F) as AB-carrier was initiated.In vitro pretreatment of Dacron with the gentamicin derivative and F wasfollowed by constant AB release for 3 weeks. In a subsequent animal study, four Dacron rings with different pretreatment were implanted in thedescending aorta of 10 pigs after direct contamination with 10(8)Staphylococcus aureus solution. One ring was pretreated with the AB/Fcompound, a second ring with the AB alone. Ring 3 (no pretreatment) andring 4 (F alone) served as controls. After 1 week, the sewing rings andtheir corresponding implantation sites were assayed for measurement ofAB-content and for culture. The AB content of AB/F-rings was 24.99 ± 7.16micrograms/g wet weight, while rings pretreated with the AB alone containedno measurable drug amounts with the exception of one specimen (0.5microgram/g) (AB/F vs. AB- rings: P > 0.0005). The correspondingimplantation sites to AB/F rings contained 1.07 ± 0.54 micrograms/g AB, whereas in only 2 of 10 implantation sites of AB rings, low AB levels werefound (0.05 and 0.2 micrograms/g) (AB/F vs. AB ring implantation sites: P > 0.0005). While all control rings and 9 of 10 AB rings wereinfected, 5 of 10 AB/F rings remained sterile after culture (AB/F vs. ABrings: P = 0.05). This finding correlated with the AB content in the suturerings. © Springer-Verlag.