Homograft Aortic Root Replacement for Destructive Prosthetic Valve Endocarditis: Results in the Current Era

• Published in: Journal of clinical medicine 2024-08, Vol.13 (15), p.4532
• Main Authors: Pocar, Marco, Barbero, Cristina, Marro, Matteo, Ferrante, Luisa, Costamagna, Andrea, Fazio, Luigina, La Torre, Michele, Boffini, Massimo, Salizzoni, Stefano, Rinaldi, Mauro
• Format: Article
• Language: English
• Subjects: Abscesses; Care and treatment; Diagnosis; Ejection fraction; Endocarditis; Evaluation; Extracorporeal membrane oxygenation; Heart valve replacement; Homografts; Infections; Infective endocarditis; Medical prognosis; Mortality; Patient outcomes; Patients; Prostheses; Regression analysis; Surgery; Sutures; Variables
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13154532

Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. A retrospective analysis was conducted on 61 consecutive patients who underwent a cardiac reoperation comprising homograft aortic root replacement since 2010. The probabilities of survival were calculated with the Kaplan-Meier method, whereas multivariable regression served to outline the predictors of adverse events. The endpoints were operative/late death, perioperative low cardiac output and renal failure, and reoperations. The operative (cumulative hospital and 30-day) mortality was 13%. The baseline aspartate transaminase (AST) and associated mitral procedures were predictive of operative death ( = 0.048, OR [95% CIs] = 1.03 [1-1.06]) and perioperative low cardiac output, respectively ( = 0.04, OR [95% CIs] = 21.3 [2.7-168.9] for valve replacement). The latter occurred in 12 (20%) patients, despite a normal ejection fraction. Survival estimates (±SE) at 3 months, 6 months, 1 year, and 3 years after surgery were 86.3 ± 4.7%, 82.0 ± 4.9%, 75.2 ± 5.6, and 70.0 ± 6.3%, respectively. Survival was significantly lower in the case of AST ≥ 40 IU/L ( = 0.04) and aortic cross-clamp time ≥ 180 min ( = 0.01), but not when excluding operative survivors. Five patients required early (two out of the five, within 3 months) or late (three out of the five) reoperation. : Homograft aortic root replacement for destructive prosthetic valve endocarditis can currently be performed with a near 90% operative survival and reasonable 3-year mortality and reoperation rate. AST might serve to additionally stratify the operative risk.