Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Medical Device Infections

Background:

• Endocarditis following the Bentall procedure presents significant challenges, often leading to complications like pseudoaneurysm or mediastinitis.
• Conservative treatment for Bentall procedure-related endocarditis is generally ineffective, necessitating surgical intervention.
• Reoperation for this condition is complex and carries substantial risks.

Purpose of the Study:

• To evaluate the short- and midterm outcomes of patients undergoing reoperation for endocarditis after a Bentall procedure.
• To identify risk factors associated with mortality in this patient cohort.

Main Methods:

• A retrospective analysis of 73 patients from an Italian registry who underwent reoperation for Bentall procedure-related endocarditis.
• Data collected included patient demographics, comorbidities, preoperative conditions, pathogens, surgical procedures, and postoperative outcomes.
• Multivariate analysis was used to identify predictors of early death.

Main Results:

• The study included 73 patients with a mean age of 57 years, predominantly male (92%), with significant comorbidities.
• Reoperations involved various techniques, including repeat Bentall procedures and mitral valve interventions.
• Hospital mortality was 15%, with urgent surgery identified as a risk factor for early death. Five- and 8-year survival rates were 75% and 71%, respectively, with uncommon endocarditis relapse.

Conclusions:

• Surgical reintervention is an effective treatment for endocarditis after the Bentall procedure, offering favorable midterm survival.
• Despite high perioperative mortality and morbidity, surgery is superior to conservative management.
• Endocarditis relapse appears to be infrequent following successful surgical treatment.