Redo aortic root replacement for acute infective endocarditis: A tension-free proximal suturing technique

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Aortic Root Replacement

Background:

• Acute infective endocarditis (IE) post-aortic root replacement (ARR) presents significant challenges.
• Periannular complications and aortic root dehiscence risk complicate prognosis.
• A modified Bentall procedure with tension-free proximal suturing was developed to address these issues.

Purpose of the Study:

• To evaluate the outcomes of a modified Bentall procedure in patients with IE after ARR.
• To assess mortality, reintervention rates, and endocarditis recurrence.
• To determine the safety and efficacy of the tension-free suturing technique.

Main Methods:

• Retrospective analysis of 20 patients with IE on ARR between 2014-2021.
• Utilized a modified Bentall technique with a graft, pseudosinuses, and a valve prosthesis.
• Employed a tension-free proximal suturing method, keeping 5mm of the tube under the prosthesis.

Main Results:

• Mean EuroSCORE II was 36.0%. 65% had periannular complications, 25% severe aortic regurgitation.
• 30-day mortality was 10.0%. 1-year and 6-year survival rates were 90.0% and 85.0%, respectively.
• Mean follow-up was 42 months; no endocarditis recurrence or reintervention was observed. Two cases of Bentall dehiscence occurred without reintervention.

Conclusions:

• The modified Bentall technique with tension-free proximal suturing offers encouraging results for redo ARR in IE patients.
• This technique appears to reduce complications and improve survival.
• Further studies are warranted to confirm these findings in larger cohorts.