Stentless bioprostheses: a versatile and durable solution in extensive aortic valve endocarditis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Aortic valve endocarditis with root destruction necessitates complex reconstruction.
• Homografts and stentless bioprostheses are standard for such cases.
• The Freestyle bioprosthesis offers advantages in availability and quality over homografts.

Purpose of the Study:

• To evaluate the clinical and echocardiographic outcomes of the Freestyle stentless bioprosthesis.
• To assess its efficacy in reconstructing the left ventricular outflow tract (LVOT) after debridement for extensive aortic valve endocarditis.

Main Methods:

• A retrospective study of 54 patients (55 Freestyle prostheses) between 2000-2014.
• Patients had aortic valve endocarditis involving the aortic root.
• Median follow-up was 3.5 years.

Main Results:

• Early and late mortality rates were 11% and 14%, respectively.
• Estimated 1- and 5-year survival was 83% and 70%.
• Low rates of reoperation (1 patient) and prosthesis failure; good hemodynamic performance (mean gradient 4.3 mmHg, mild regurgitation).

Conclusions:

• The Freestyle stentless bioprosthesis is a viable option for LVOT reconstruction in extensive aortic valve endocarditis.
• It demonstrates comparable versatility and outcomes to homografts.
• Despite considerable early mortality in this high-risk group, late survival is favorable with good local control and hemodynamic function.