Stentless Root Replacement versus Tissue Valves in Infective Endocarditis - A Propensity-Score Matched Study.

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Aortic/prosthetic valve endocarditis is a high-risk condition requiring complex surgical management.
• Stentless xenografts present a potential alternative for treating challenging endocarditis cases.

Purpose of the Study:

• To evaluate the efficacy and safety of the Medtronic Freestyle stentless xenograft in full-root technique for endocarditis.
• To compare outcomes of Freestyle valve root reconstruction with other tissue valves.

Main Methods:

• Propensity score matching (nearest neighbor) comparing 54 patients treated with Medtronic Freestyle (FS group) versus 54 patients treated with other tissue valves (Tissue group).
• Analysis of hospital mortality, recurrent infection rates, and freedom from reoperation over a median follow-up of 2.7 years (367 patient-years).

Main Results:

• Hospital mortality was 16.7% in the FS group vs. 25.6% in the Tissue group (P=0.24).
• Coronary heart disease was a significant predictor of early mortality (P=0.004).
• Recurrent infection rates were low (1.8%) and freedom from reoperation was 97.2%.

Conclusions:

• The stentless xenograft is a viable option for valve/root/prosthetic endocarditis, offering low reinfection rates and enabling complex reconstructive procedures.
• Excluding infected tissue may benefit patients by reducing bacteremia and recurrent infections.
• The stentless bioroot provides versatile treatment options for future valve degeneration.