Full-root aortic valve replacement using Medtronic Freestyle bioroots for infective endocarditis

Area of Science:

• Cardiovascular Surgery
• Infective Diseases
• Biomaterials Science

Background:

• Infective endocarditis poses significant challenges in aortic root reconstruction.
• Homografts are often used but have limitations in availability and durability.
• The Medtronic Freestyle bioroot presents a potential alternative for complex aortic root repairs.

Purpose of the Study:

• To evaluate the efficacy of the Medtronic Freestyle bioroot in treating aortic endocarditis.
• To assess outcomes of aortic root replacement using the Freestyle bioroot in a single-centre experience.
• To compare the Freestyle bioroot to homografts for aortic root reconstruction in infective endocarditis.

Main Methods:

• Retrospective study of adult patients undergoing aortic root replacement with the Medtronic Freestyle bioroot (2015-2023).
• Inclusion criteria: infective endocarditis requiring aortic root replacement with coronary artery reimplantation (modified Bentall technique).
• Data collected on patient demographics, pathogens, surgical procedures, and clinical outcomes.

Main Results:

• Thirty patients were included; 73.3% had prosthetic valve endocarditis, and 73.3% presented with annular abscesses.
• Staphylococcus aureus was the most common pathogen (23.3%).
• One- and 5-year survival rates were 90.0% and 82.2%, respectively. Reinfection-free survival was 86.7% at 1 year and 75.5% at 5 years.

Conclusions:

• The Medtronic Freestyle bioroot is a viable alternative to homografts for aortic endocarditis treatment.
• It is particularly suitable for cases requiring aortic root reconstruction after extensive debridement of annular abscesses.
• The bioroot offers comparable outcomes to homografts with potential advantages in durability and availability.