Full-root aortic valve replacement using Medtronic Freestyle bioroots for infective endocarditis

OBJECTIVES This study aims to explore the potential efficacy of the Freestyle Medtronic bioroot in the treatment of aortic endocarditis, based on our single-centre experience.METHODS In this retrospective study conducted between 2015 and 2023, adult patients who underwent aortic root replacement with coronary arteries reimplantation using the modified Bentall technique with a Medtronic Freestyle bioroot in our centre for infective endocarditis were included.RESULTS Thirty patients, with five deaths, no cases of relapse and two cases of reinfection, were included, and prosthetic valve endocarditis represented 73.3% of cases. The median age was 66 years (IQR 14.5 years), and 24/30 (80%) were male. Median EuroSCORE II was 12.2% (IQR 13.9%). The most commonly identified pathogen was Staphylococcus aureus (eight cases; 23.3%). Fourteen additional procedures were performed on 12 patients. Annular abscess was present in 73.3% of cases and required annulus patch repair in 13/22 (59%). Early reoperation rate was 20%, mostly for surgical bleeding. One- and 5-year actuarial survival rates were 90.0 and 82.2%, respectively. There were no cases of relapse, and reinfection-free survival was 86.7% at 1 year and 75.5% at 5 years. Postoperative mean and maximal transvalvular gradients were 7 (IQR 3.3 mmHg) and 14.6 mmHg (IQR 4.6 mmHg), respectively.CONCLUSIONS The Medtronic Freestyle bioroot could be a valid alternative to homografts for the treatment of infective endocarditis, particularly in cases necessitating aortic root reconstruction after extensive debridement of annular abscesses, with comparable outcomes and potential advantages in terms of durability and availability. Infective endocarditis remains a complex entity, associated with high mortality and severe complications, and cases requiring surgery even more so.