Surgical Treatment of Aortic Prosthetic Valve Endocarditis: A 20-Year Single-Center Experience

Despite progress in diagnostic methods and treatment, aortic prosthetic valve endocarditis (PVE) remains a life-threatening disease. We report the outcome of all operations for aortic PVE performed at our institution over the past 20 years.

Eighty-seven operations performed in 84 patients between 1993 and 2013 were included in this retrospective study. An aortic homograft was used in 56 (64%) cases, a mechanical prosthesis was used in 20 (23%) cases, and a bioprosthesis was used in 11 (13%) cases. Early and late complications and mortality were compared between the first and second decades of our experience. Predictors of mortality were identified with Cox regression. Mean follow-up was 5.5 years (range 0-17 years).

Nine patients (10%) died within 30 days, and severe perioperative complications occurred in 36 patients (41%). Overall cumulative survival was 80% at 5 years and 65% at 10 years. Four (12.9%) of the patients treated with mechanical or biological prostheses had a recurrent episode of endocarditis, compared with none of the patients treated with homografts (p = 0.006). During the second decade, 30-day mortality was lower (3.6% versus 22%; p = 0.007) and 5-year cumulative survival was higher (88% versus 66%; p = 0.027). Age, preoperative serum creatinine, and severe perioperative complications were independent predictors of mortality during follow-up.

Aortic PVE is associated with a high rate of early complications and substantial early mortality. Patients who survive the immediate postoperative period have satisfactory long-term survival. The risk of recurrent endocarditis is low, especially in patients treated with homografts. The results have improved during the past decade.