Homograft aortic root replacement in native or prosthetic active infective endocarditis: Twenty-year single-center experience

Objective

We compared early and long-term results of cryopreserved homograft aortic root replacement in native valve endocarditis or prosthetic valve endocarditis associated with periannular abscess.

Methods

Between May 1986 and December 2007, 1163 patients with endocarditis were operated upon. Of these, 221 patients (n = 185 men, median age 55 years) had homograft aortic root replacement due to 99 cases of native valve endocarditis (45%) and 122 of prosthetic valve endocarditis (55%). Perinannular abscess developed in 189 patients (86%), and aortoventricular dehiscence in 120 (63.5%) of them. Perioperative characteristics, probability of survival, freedom from recurrence, and reoperation were analyzed. Follow-up (mean 5.2 ± 0.4 years, maximum 18.4 years) was completed in 96.8% with a total of 1127 patient-years.

Results

Overall native valve endocarditis survival at 30 days and 1, 5, and 10 years was 83.8% ± 3.7%, 76.6% ± 4.3%, 66.5% ± 4.9%, and 47.3% ± 5.6%, respectively, significantly better than for patients with prosthetic valve endocarditis, who had a greater tendency toward abscess formation (P = .029). Thirty-one patients (14.0%) required reoperation either for structural valve deterioration (n = 19, 8.6%), with a greater tendency in patients aged <40 years, or for recurrent endocarditis of the homograft (n = 12, 5.4%). One-year reoperation mortality rate was 16.1% (n = 5).

Conclusions

Homograft aortic root replacement in active infective endocarditis with periannular abscess formation shows satisfactory early and long-term results with significantly better survival in native valve endocarditis than prosthetic valve endocarditis. It is associated with a low recurrence rate, although the risk of structural valve deterioration increases over time, especially in young patients, and reoperation remains a challenge. In our institution, the homograft remains the preferred valve substitute in active infective endocarditis with periannular abscess formation.

CTSNet classification: 35, 18

Abbreviations and Acronyms: AIE, active infective endocarditis, ARR, aortic root replacement, NVE, native valve endocarditis, PVE, prosthetic valve endocarditis, SVD, structural valve deterioration