Annular reconstruction in infective endocarditis: Comparative analysis of surgical outcomes and infection recurrence

Infective endocarditis (IE) presents significant clinical challenges, particularly when the infection extends to the cardiac valve annulus, resulting in severe complications, such as abscesses and fistula formation. Annular reconstruction (AR) has emerged as a crucial surgical technique aimed at eradicating infections and restoring the cardiac anatomy. This study aimed to demonstrate the efficacy of AR by comparing the postoperative outcomes and recurrence rates between the 2 groups. This retrospective study analyzed 91 patients who underwent valve surgery for IE and categorized them into 2 groups: those who underwent AR (AR, n = 52) and those who did not (non-AR, n = 39). Surgical decisions for AR were based on intraoperative findings of annular involvement. The AR group had a higher prevalence of risk factors associated with poorer prognosis, including the presence of prosthetic valves (P = .01), annular invasion, prolonged operative time, cardiopulmonary bypass time, and aortic cross-clamp time (P < .01). However, there were no significant differences between the AR and non-AR groups in terms of intensive care unit or hospital stay, postoperative complications such as stroke, bleeding, renal replacement therapy, or 30-day mortality. Additionally, the recurrence rates of IE and neurological outcomes were similar across both the groups. Despite greater surgical complexity and more severe initial infection in the AR group, AR was performed safely without increasing postoperative morbidity or mortality. This suggests that AR effectively manages extensive IE involving the annulus by allowing comprehensive removal of infected tissue.