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

Acute infective endocarditis after aortic root replacement is challenging. Peri-annular complications are often present and worsen the prognosis due to the risk of aortic root dehiscence. We perform a modified Bentall procedure with a tension-free proximal suturing technique. The aim of this study was to describe the results of this technique in terms of mortality, reintervention and endocarditis recurrence.

We retrospectively analysed the data of 20 patients undergoing surgery for acute infective endocarditis on aortic root replacement between 2014 and 2021. The surgical technique involved a graft with pseudosinuses and an aortic valve prosthesis sutured to this tube, keeping 5 mm of the tube under the prosthesis, allowing tension-free suturing between the reconstructed aortic annulus and the graft. Primary end-points were overall mortality and reintervention at 1 year.

The median age was 57.9 years (26.0-77.0), 80.0% patients were men, and mean EuroSCORE II was 36.0% (± 17.7). Thirteen patients (65.0%) had periannular complications, 5 patients (25.0%) had severe aortic regurgitation. At 30 days, the overall mortality rate was 10.0% (2 patients). The Kaplan-Meier survival estimates at 1-year and 6-years were 90.0% and 85.0%, respectively. During a mean 42-month (± 44.5) follow-up period, no recurrence of endocarditis or reintervention was observed. Two patients experienced Bentall dehiscence without need for reintervention.

The use of a modified Bentall technique with tension-free proximal suturing yields encouraging outcomes for patients undergoing redo aortic root replacement for acute infective endocarditis.