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. 2020 Jun 1;35(3):265-273.
doi: 10.21470/1678-9741-2020-0020.

Surgical Options for Aortic Root Replacement in Destructive Endocarditis

Marcin Szczechowicz  1 , Alexander Weymann  1 , Sabreen Mkalaluh  1 , Ahmed Mashhour  1 , Konstantin Zhigalov  1 , Jerry Easo  1
Affiliations

Surgical Options for Aortic Root Replacement in Destructive Endocarditis

Marcin Szczechowicz et al. Braz J Cardiovasc Surg. .

Abstract

Objective: To analyze patients' preoperative characteristics, surgical data, postoperative courses, and short- and long-term outcomes after implantation of different full-root prostheses for destructive aortic valve endocarditis.

Methods: Between 1999 and 2018, 80 patients underwent aortic root replacement due to infective endocarditis in our institution. We analyzed the abovementioned data with standard statistical methods.

Results: The Freestyle stentless porcine prostheses were implanted in 53 (66.25%) patients, biological valve conduits in 13 (16.25%), aortic root homografts in nine (11.25%), and mechanical valve conduits in five (6.25%). There were no significant preoperative differences between the groups. The incidence of postoperative complications and intensive care unit length of stay did not differ significantly between the groups. The 30-day mortality rate was low among Freestyle patients (n=8, 15.1%) and high in the mechanical conduit cohort (n=3, 60%), though with borderline statistical significance (P=0.055). The best mean survival rates were observed after homograft (13.7 years) and stentless prosthesis (8.1 years) implantation, followed by biological (2.8 years) and mechanical (1.4 years) conduits (P=0.014). The incidence of reoperations was low in the mechanical conduit group (0) and stentless bioroot group (n=1, 1.9%), but two (15.4%) patients with biological conduits and three (33.3%) patients with homografts required reoperations in the investigated follow-up period (P=0.005).

Conclusion: In patients with the destructive form of aortic valve endocarditis, homografts and stentless porcine xenografts offer better survival rates than stented valve conduits; however, the reoperation rate among patients who received homograft valves is high.

Keywords: Allografts; Aortic Valve; Endocarditis, Bacterial; Heterografts; Reoperation; Stents; Transplantation, Heterologous.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Analyzed options for aortic root replacement (in the middle) due to destructive endocarditis. A) Stentless porcine xenograft, B) biological valve conduit, C) homograft, D) mechanical valve conduit.
Fig. 2
Fig. 2
Survival curves for all four analyzed groups.
Fig. 3
Fig. 3
Cumulative freedom from composite endpoint for all four surgical options.
See this image and copyright information in PMC

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