JTCVS techniques · 2025
Mid-term outcomes of a modified prosthetic aortic valve implantation technique for prosthetic valve endocarditis complicated by aortic annular abscess.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Nasso Giuseppe, Vignaroli Walter, Bonifazi Raffaele, Fiore Flavio, Schinco Giacomo, Agrò Felice, Greco Ernesto, Valenzano Antongiulio, Errico Giacomo, Hila Dritan, Loizzo Tommaso, Santarpino Giuseppe, Speziale Giuseppe
Аннотация
BACKGROUND: Prosthetic valve endocarditis (PVE) complicated by complex paraannular aortic abscess remains a surgical challenge. We aimed to evaluate the mid-term outcomes of a standardized, patch-free, supra-annular aortic valve replacement strategy that avoids complete root replacement in these high-risk patients.
METHODS: This retrospective, single-center study included 70 consecutive patients treated between 2015 and 2023 for complex aortic PVE using a consistent surgical protocol: radical debridement, supra-annular prosthetic valve implantation, inside the Valsalva sinuses, and external felt reinforcement-without annular or root patching. Follow-up included annual clinical and echocardiographic assessment (mean duration, 5.2 ± 1.3 years). The primary endpoint was freedom from the composite of reinfection or aortic reoperation. Secondary endpoints included survival, valve performance, and predictors of late adverse events.
RESULTS: Hospital mortality was 5.7% (n = 4 of 70). At 5 years, overall survival was 86.0% (95% confidence interval [CI], 78.0%-93.9%), and freedom from reinfection or aortic reoperation was 89.2% (95% CI, 82.1%-96.2%). Outcomes were comparable between the original (n = 47) and expanded (n = 23) cohorts (log-rank P = .71). Two late reinfections (2.9%) were managed medically. One patient required reoperation for structural valve degeneration at 54 months. Mean transvalvular gradient remained stable at 5 years (10.4 ± 3.1 mm Hg at discharge vs 11.1 ± 3.6 mm Hg; P = .27) whereas mean left ventricular ejection fraction improved significantly (from 52 ± 10% to 58 ± 8%; P < .01). Ninety-two percent of survivors were in New York Heart Association class I-II. Independent predictors of late events included EuroSCORE II >12% and incomplete abscess excision.
CONCLUSIONS: Patch-free supra-annular valve replacement offers durable infection control and excellent hemodynamic outcomes, avoiding the need for complete root replacement in complex aortic PVE.
METHODS: This retrospective, single-center study included 70 consecutive patients treated between 2015 and 2023 for complex aortic PVE using a consistent surgical protocol: radical debridement, supra-annular prosthetic valve implantation, inside the Valsalva sinuses, and external felt reinforcement-without annular or root patching. Follow-up included annual clinical and echocardiographic assessment (mean duration, 5.2 ± 1.3 years). The primary endpoint was freedom from the composite of reinfection or aortic reoperation. Secondary endpoints included survival, valve performance, and predictors of late adverse events.
RESULTS: Hospital mortality was 5.7% (n = 4 of 70). At 5 years, overall survival was 86.0% (95% confidence interval [CI], 78.0%-93.9%), and freedom from reinfection or aortic reoperation was 89.2% (95% CI, 82.1%-96.2%). Outcomes were comparable between the original (n = 47) and expanded (n = 23) cohorts (log-rank P = .71). Two late reinfections (2.9%) were managed medically. One patient required reoperation for structural valve degeneration at 54 months. Mean transvalvular gradient remained stable at 5 years (10.4 ± 3.1 mm Hg at discharge vs 11.1 ± 3.6 mm Hg; P = .27) whereas mean left ventricular ejection fraction improved significantly (from 52 ± 10% to 58 ± 8%; P < .01). Ninety-two percent of survivors were in New York Heart Association class I-II. Independent predictors of late events included EuroSCORE II >12% and incomplete abscess excision.
CONCLUSIONS: Patch-free supra-annular valve replacement offers durable infection control and excellent hemodynamic outcomes, avoiding the need for complete root replacement in complex aortic PVE.