Homograft Aortic Root Replacement for Destructive Prosthetic Valve Endocarditis: Results in the Current Era

Author:

Pocar Marco123ORCID,Barbero Cristina12,Marro Matteo12ORCID,Ferrante Luisa12ORCID,Costamagna Andrea24,Fazio Luigina5,La Torre Michele12,Boffini Massimo12,Salizzoni Stefano12ORCID,Rinaldi Mauro12

Affiliation:

1. Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy

2. Department of Surgical Sciences, University of Turin, 10126 Turin, Italy

3. Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy

4. Cardiac Intensive Care Unit, Department of Anaesthesia, Intensive Care and Emergency, Città della Salute e della Scienza, 10126 Turin, Italy

5. Tissue Bank, Città della Salute e della Scienza, 10126 Turin, Italy

Abstract

Background: Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. Methods: A retrospective analysis was conducted on 61 consecutive patients who underwent a cardiac reoperation comprising homograft aortic root replacement since 2010. The probabilities of survival were calculated with the Kaplan–Meier method, whereas multivariable regression served to outline the predictors of adverse events. The endpoints were operative/late death, perioperative low cardiac output and renal failure, and reoperations. Results: The operative (cumulative hospital and 30-day) mortality was 13%. The baseline aspartate transaminase (AST) and associated mitral procedures were predictive of operative death (p = 0.048, OR [95% CIs] = 1.03 [1–1.06]) and perioperative low cardiac output, respectively (p = 0.04, OR [95% CIs] = 21.3 [2.7–168.9] for valve replacement). The latter occurred in 12 (20%) patients, despite a normal ejection fraction. Survival estimates (±SE) at 3 months, 6 months, 1 year, and 3 years after surgery were 86.3 ± 4.7%, 82.0 ± 4.9%, 75.2 ± 5.6, and 70.0 ± 6.3%, respectively. Survival was significantly lower in the case of AST ≥ 40 IU/L (p = 0.04) and aortic cross-clamp time ≥ 180 min (p = 0.01), but not when excluding operative survivors. Five patients required early (two out of the five, within 3 months) or late (three out of the five) reoperation. Conclusions: Homograft aortic root replacement for destructive prosthetic valve endocarditis can currently be performed with a near 90% operative survival and reasonable 3-year mortality and reoperation rate. AST might serve to additionally stratify the operative risk.

Publisher

MDPI AG

Reference32 articles.

1. Khalil, H., and Soufi, S. (2024, February 05). Prosthetic Valve Endocarditis, StatPearls [Internet], Available online: https://www.ncbi.nlm.nih.gov/books/NBK567731/.

2. Contemporary clinical profile and outcome of prosthetic valve endocarditis;Wang;JAMA,2007

3. Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50–69 years;Glaser;Eur. Heart J.,2016

4. Endocarditis risk with bioprosthetic and mechanical valves: Systematic review and meta-analysis;Reddy;Heart,2020

5. Long-term risk of infective endocarditis after transcatheter aortic valve replacement;Butt;J. Am. Coll. Cardiol.,2019

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3