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12:17
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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Long-term outcomes of aortic root replacement for endocarditis.
Charles M Wojnarski1, Parth A Chodavadia2, Yaron D Barac3
1Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Journal of Cardiac Surgery
|March 2, 2021
Summary
Aortic root replacement for infective endocarditis (IE) shows acceptable risk and long-term survival comparable to other indications. Homografts and stentless bioprosthetic roots offer excellent durability for IE patients up to 15 years.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Prosthetic Valve Research
Background:
- Aortic valve and root infective endocarditis (IE) presents high surgical risks.
- Long-term outcomes and optimal surgical choices for IE patients are not well-documented.
Purpose of the Study:
- To evaluate the long-term survival and reoperation rates after aortic root replacement in patients with and without infective endocarditis.
- To compare the durability of different prosthetic conduits (homograft vs. stentless bioprosthetic) in endocarditis patients.
Main Methods:
- A retrospective analysis of 485 patients undergoing aortic root and valve replacement between 1976 and 2013.
- Cox proportional hazard models and cumulative incidence functions were used to assess survival and reoperation risks, with death as a competing risk.
Main Results:
- Infective endocarditis (IE) was the indication for operation in 14.6% of patients.
- Survival at 15 years was similar for IE and non-IE patients (37.3% vs. 42.5%, p=0.13) after multivariable adjustment (HR: 1.1; 95% CI: [0.77, 1.62]).
- Freedom from reoperation at 15 years did not significantly differ by endocarditis status (95.9% vs. 73.6%, p=0.07); homografts and stentless bioprosthetic roots showed similar durability in IE patients (95.3% vs. 88.5% freedom from reoperation at 10 years).
Conclusions:
- Aortic root replacement for infective endocarditis demonstrates acceptable surgical risk and long-term survival comparable to other indications.
- Both homograft and stentless bioprosthetic aortic root replacements provide excellent durability for up to 15 years in patients with infective endocarditis.
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