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. 2021 Jun;36(6):1969-1978.
doi: 10.1111/jocs.15472. Epub 2021 Mar 2.

Long-term outcomes of aortic root replacement for endocarditis

Charles M Wojnarski  1 , Parth A Chodavadia  2 , Yaron D Barac  3 , Jenna L Armstrong  2 , Andrew M Vekstein  1 , John C Haney  1 , Jeffrey G Gaca  1 , G Chad Hughes  1 , Donald D Glower  1
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Long-term outcomes of aortic root replacement for endocarditis

Charles M Wojnarski et al. J Card Surg. 2021 Jun.

Abstract

Background: Infective endocarditis (IE) involving the aortic valve and root is associated with high risk requiring thoughtful surgical decision-making. The impact of valve and conduit choices and patient factors on long-term outcomes in this patient population is poorly documented.

Methods: From January 1976 to December 2013, 485 patients underwent aortic root and valve replacement at a single institution. Cox's proportional hazard model identified predictors of long-term survival and cumulative incidence functions were compared to assess need for reoperation with death as a competing risk.

Results: Median age at time of operation was 56.6 years (interquartile range: 23.1) with the indication for operation being endocarditis in 14.6% (n = 71). Stentless root replacement was used in 70% IE versus 34% non-IE (p < .001). Endocarditis at time of root replacement did not have a significant impact on survival through 15 years (IE: 37.3% vs. non-IE: 42.5%; log-rank; p = .13). After multivariable adjustment, survival was similar between patients with and without endocarditis (hazard ratio: 1.1; 95% confidence interval: [0.77, 1.62]; p = .57). Freedom from reoperation at 15 years did not vary significantly by endocarditis status (IE: 95.9% vs. non-IE: 73.6%; p = .07). Among endocarditis patients, freedom from reoperation at 10 years was similar between homograft and stentless bioprosthetic conduits (95.3% vs. 88.5%; log-rank; K-sample; p = .46).

Conclusions: In a sample with frequent use of stentless prostheses, aortic root replacement for infective endocarditis had acceptable risk and long-term survival similar to root replacement for other indications. In the setting of endocarditis, root replacement with homograft or stentless bioprosthetic root has excellent durability through 15 years.

Keywords: aortic root; aortic valve; endocarditis.

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References

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