Key result
Subannular implantation of a biological valved conduit in high-risk patients with infective endocarditis and previous cardiac surgery resulted in a 30-day mortality of 13.8%.
Why the study?
Aortic root replacement with a valved conduit for infective endocarditis with extensive peri-annular abscesses and aortic root involvement is life-threatening and surgically challenging.
Does sub-annular implantation of a biological valved conduit provide safe and effective outcomes in high-risk patients with aortic root endocarditis and prior cardiac surgery?
Observational (n=29)
Yes
Does sub-annular implantation of a biological valved conduit provide safe and effective outcomes in high-risk patients with aortic root endocarditis and prior cardiac surgery?
Sub-annular implantation of a 100% pericardial valved conduit is a feasible and effective surgical option for high-risk patients with aortic root endocarditis and prior cardiac surgery, showing acceptable 1-year outcomes.
Subannular bioconduit use yields acceptable early mortality in high-risk redo IE with root abscess; leaves open comparative efficacy versus standard root replacement.
OBJECTIVES: Infective endocarditis (IE) with extensive peri-annular abscesses and aortic root involvement is a life-threatening disease. Aortic root replacement with a valved conduit is the most common intervention in this setting and represents a serious challenge for the surgeon. In the present two-center study we analyzed early and midterm outcomes of a high-risk series of IE patients undergoing aortic root reconstruction with a sub-annular implantation of a totally biological valved conduit at our centers. METHODS: The series comprised 29 patients (18 males, mean age: 72.3 ± 10.1 years) operated at "Lancisi Cardiovascular Center" of Ancona and "Pasquinucci Heart Hospital" of Massa, Italy, between May 2016 and October 2019. All patients had undergone a previous cardiac surgery. Median Euroscore-II was 12.6%. Following aggressive debridement, a Bioconduit was implanted using a sub-annular implantation technique in all cases. RESULTS: Thirty-day mortality was 13.8% (n = 4). Multiorgan failure was cause of death in all cases. Respiratory complications occurred in eight patients (27.6%). Renal complications requiring temporary or permanent dialysis occurred in six (20.7%) and two (6.9%) patients, respectively. Mortality and morbidity were not related to the surgical approach. At 1-year follow-up three patients died and no patients underwent reoperation neither reported endocarditis of the biological conduit. CONCLUSION: Considered the high-risk profile of the study cohort, our results suggest safety and efficacy of our approach at 1-year. Indeed, we contend that our subannular implantation of a 100% pericardial valved conduit, allowing an effective abscess exclusion and a conduit anchoring to healthy tissues, can reduce the risk of reinfection and dehiscence.
No takes yet. Share an insight, caveat, or question.
Cefarelli et al. (2020) conducted an observational in Infective endocarditis with extensive peri-annular abscesses and aortic root involvement (n=29). Sub-annular implantation of a totally biological valved conduit (Bioconduit) was evaluated on Thirty-day mortality. Subannular implantation of a biological valved conduit in high-risk patients with infective endocarditis and previous cardiac surgery resulted in a 30-day mortality of 13.8%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: