Stentless Root Replacement versus Tissue Valves in Infective Endocarditis – A Propensity-Score Matched Study

Abstract

Introduction People with aortic/prosthetic valve endocarditis are a high-risk cohort of patients who present a challenge for all medically involved disciplines and who can be treated by various surgical techniques. Methods We analyzed the results of treatment of root endocarditis with Medtronic Freestyle® in full-root technique over 19 years (1999-2018) and compared them against treatment with other tissue valves. Comparison was made with propensity score matching, using the nearest neighbor method. Various tests were performed as suited for adequate analyses. Results Fifty-four patients in the Medtronic Freestyle group (FS group) were matched against 54 complex root endocarditis patients treated with other tissue valves (Tissue group). Hospital mortality was 9/54 (16.7%) in the FS group vs . 14/54 (25.6%) in the Tissue group ( P =0.24). Cox regression performed for early results demonstrated coronary heart disease ( P =0.004, odds ratio 2.3), among others, influencing early mortality. Recurrent infection was low (1.8% for FS and Tissue patients) and freedom from reoperation was 97.2% at a total of 367 patient-years of follow-up (median of 2.7 years). Conclusion The stentless xenograft is a viable alternative for treatment of valve/root/prosthetic endocarditis, demonstrating a low rate of reinfection. The design of the bioroot allows for complex reconstructive procedures at the outflow tract and the annular level with at an acceptable operative risk. Endocarditis patients can be treated excluding infective tissue from the bloodstream, possibly with benefits, concerning bacteremia and recurrent infection. Furthermore, the use of the stentless bioroot offers varying treatment options in case of future valve degeneration.

The Surgical Treatment of Infective Endocarditis: A Comprehensive Review

“…At 10 years postoperation, the stentless graft group reported 98% freedom from endocarditis, versus 88% in the stented group, while the risk of reoperation was 12.4% in the stented group versus only 3.4% in the stentless valve group. Easo et al [ 49 ] propensity-matched stentless Medtronic Freestyle with other tissue valves for full root endocarditis. The group reported a freedom from reoperation with the Medtronic Freestyle to be 97.2% at a median of 2.7 years postoperatively.…”

Surgical redo mitral valve replacement in high‐risk patients: The real‐world experience

“…The following result could be explained through a high portion of patients presenting with infective endocarditis (37.9%) and 51.7% of patients requiring at least one concomitant procedure. Both procedures initially carry higher risks when compared with isolated redo SMVR 14–18 . To present the discrepancy in the outcomes, we divided our cohort (as previously mentioned) into two groups and analyzed their separate mortality rates.…”

“…Both procedures initially carry higher risks when compared with isolated redo SMVR. [14][15][16][17][18] To present the discrepancy in the outcomes, we divided our cohort (as previously mentioned) into two groups and analyzed their separate mortality rates. Patients who underwent an isolated redo SMVR showed 30-day mortality of 10.7%, while the patients with at least one additional concomitant procedure presented with significantly higher mortality of 33%, which could be explained through the complexity of the procedure and the comorbidities of the patients.…”