A 20-year experience with cryopreserved allografts as the valve replacement of choice in aortic root reconstruction for destructive endocarditis with abscess formation

Abstract

Abstract

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 peri-annular abscess formation.

METHODS From 2001 to 2021, 110 consecutive patients with active infective endocarditis and peri-annular abscess, underwent a cryopreserved allograft root replacement. In 100 patients (91%), the operation was performed <48 h 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-day mortality was 18% (20 patients). Freedom from reintervention was 98.3% (standard deviation: 1.7) at 1 year and 83.3% (standard deviation: 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 (odds ratio: 22.75, 95% confidence interval: 4.79–108.14, P < 0.001), ejection fraction under 30% (odds ratio: 17.91, 95% confidence interval: 3.27–98.01, P < 0.001) and stroke within 14 days prior to operation (odds ratio: 5.21, 95% confidence interval: 1.28–21.2, P = 0.021) were incremental factors associated with the 30-day mortality.

CONCLUSIONS In aortic root endocarditis with abscesses formation, cryopreserved allografts exhibit excellent clinical performance with a low rate of reinfection and reintervention, which make 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-day mortality.