Aortic Root Involvement in Prosthetic Valve Endocarditis Treatment: Strategies and Outcomes

Background: Prosthetic valve endocarditis (PVE) with destruction of the aortic root can be disastrous, with a high rate of morbidities and mortality. Current guidelines do not recommend any particular type of prostheses in the setting of infective endocarditis. However, homografts and stentless prostheses are recommended in the setting of extensive tissue destruction. In this study, we share our 16-year experience and outcomes with destructive aortic prosthetic valve endocarditis.

Method: We reviewed the patients who were admitted to our tertiary care institution between January 2005 and December 2021, for surgery for infective endocarditis. Data were collected as part of the routine patient care. Data are presented as medians (25th–75th percentiles), absolute numbers, and percentages.

Results: A total of 189 patients were admitted for aortic PVE. This revealed 50 patients with root destruction requiring aortic root replacement (RR group) and 139 patients with intact aortic roots (RI group). The EuroSCORE II in the RR group was higher than that in the RI group (27.1% [20.5–42.4] vs. 20.9% [16.5–33.2], p < 0.006). Patients in the RR group were significantly younger than those in the RI group (66 [54–72] years vs. 71 [64–78] years, p < 0.001). In the RR group, 44 patients were male (88.0%) and was comparable to the RI group (122 [87.8%], p = 1.000). Paravalvular leakages were observed in 35 patients (p = 0.089). In the RR group, pericardial valved conduits were used in 26 patients (52.0%), homografts in 10 patients (20.0%), biological valved conduits in 10 patients (20.0%), and mechanical valve conduits in 4 patients (8.0%), respectively. There were no differences in the rates of postoperative adverse cerebrovascular events, septic shock, ECLS, and IABP (p = 1.000, p = 0.849, p = 0.073, and p = 1.000, respectively). A significantly higher rate of in-hospital mortality was observed in the RR group (17 [34.0%] vs. 21 [15.1%], p = 0.007). Survival at 5 years was 57% in the RR group and 61% in the RI group (p = 0.205).

Conclusion: The early result following root replacement for infective endocarditis is comparable to current literature. Aortic root destruction is not an uncommon and highly relevant complication, especially in early aortic PVE. Surgical treatment of PVE for aortic root destruction results in significantly higher in-hospital mortality, but provides comparable median survival for survivors.

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Artikel online veröffentlicht:
28. Januar 2023