Long-term outcomes of aortic root replacement for endocarditis

Charles M. Wojnarski, Parth A. Chodavadia, Yaron D. Barac, Jenna L. Armstrong, Andrew M. Vekstein, John C. Haney, Jeffrey G. Gaca, G. Chad Hughes, Donald D. Glower

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Infective endocarditis (IE) involving the aortic valve and root is associated with high risk requiring thoughtful surgical decision-making. The impact of valve and conduit choices and patient factors on long-term outcomes in this patient population is poorly documented. Methods: From January 1976 to December 2013, 485 patients underwent aortic root and valve replacement at a single institution. Cox's proportional hazard model identified predictors of long-term survival and cumulative incidence functions were compared to assess need for reoperation with death as a competing risk. Results: Median age at time of operation was 56.6 years (interquartile range: 23.1) with the indication for operation being endocarditis in 14.6% (n = 71). Stentless root replacement was used in 70% IE versus 34% non-IE (p <.001). Endocarditis at time of root replacement did not have a significant impact on survival through 15 years (IE: 37.3% vs. non-IE: 42.5%; log-rank; p =.13). After multivariable adjustment, survival was similar between patients with and without endocarditis (hazard ratio: 1.1; 95% confidence interval: [0.77, 1.62]; p =.57). Freedom from reoperation at 15 years did not vary significantly by endocarditis status (IE: 95.9% vs. non-IE: 73.6%; p =.07). Among endocarditis patients, freedom from reoperation at 10 years was similar between homograft and stentless bioprosthetic conduits (95.3% vs. 88.5%; log-rank; K-sample; p =.46). Conclusions: In a sample with frequent use of stentless prostheses, aortic root replacement for infective endocarditis had acceptable risk and long-term survival similar to root replacement for other indications. In the setting of endocarditis, root replacement with homograft or stentless bioprosthetic root has excellent durability through 15 years.

Original languageEnglish
Pages (from-to)1969-1978
Number of pages10
JournalJournal of Cardiac Surgery
Volume36
Issue number6
DOIs
StatePublished - Jun 2021
Externally publishedYes

Keywords

  • aortic root
  • aortic valve
  • endocarditis

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