Objectives The aim of this retrospective study was to assess the early- and long-term outcomes following the use of cryopreserved allografts in aortic valve endocarditis with periannular abscess formation. Methods From 2001 to 2021, 110 consecutive patients with active infective endocarditis and periannular abscess, underwent a cryopreserved allograft root replacement. In 100 patients (91%), the operation was performed < 48 hours after admission due to refractory heart failure and or septic shock. In 95 patients, (86.4%) a redo operation was performed due to a prosthetic valve endocarditis. Preoperatively, 12 patients were dialysis-dependent and 30 patients suffered from a recent stroke. Results The 30-days mortality was 18% (20 patients). Freedom from reintervention was 98.3% (SD: 1.7) at 1 year and 83.3% (SD: 8.5) at 10 years. Four patients required a redo-operation. Three patients did develop re-endocarditis. Freedom from re-endocarditis was 95% after 17 years of follow-up. preoperative dialysis dependency (OR: 22.75, 95% CI: 4.79–108.14, P < 0.001), ejection fraction under 30% (OR: 17.91, 95% CI: 3.27–98.01, P < 0.001) and stroke within 14 days prior to operation (OR: 5.21, 95% CI: 1.28–21.2, P = 0.021) were incremental factors associated with the 30-days mortality. Conclusion In aortic root endocarditis with abscesses formation, cryopreserved allografts exhibit excellent clinical performance with a low rate of reinfection and reintervention, which makes its use as valve replacement a very desirable option. Dialysis dependency, ejection fraction under 30% and recent stroke have the highest impact on the 30-days mortality.
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