Surgical Treatment of Aortic Prosthetic Valve Endocarditis: A 20-Year Single-Center Experience

Background. Despite progress in diagnostic methods and treatment, aortic prosthetic valve endocarditis (PVE) remains a life-threatening disease. We report the outcome of all operations for aortic PVE performed at our institution over the past 20 years. Methods. Eighty-seven operations performed in 84 patients between 1993 and 2013 were included in this retrospective study. An aortic homograft was used in 56 (64%) cases, a mechanical prosthesis was used in 20 (23%) cases, and a bioprosthesis was used in 11 (13%) cases. Early and late complications and mortality were compared between the first and second decades of our experience. Predictors of mortality were identified with Cox regression. Mean follow-up was 5.5 years (range 0-17 years). Results. Nine patients (10%) died within 30 days, and severe perioperative complications occurred in 36 patients (41%). Overall cumulative survival was 80% at 5 years and 65% at 10 years. Four (12.9%) of the patients treated with mechanical or biological prostheses had a recurrent episode of endocarditis, compared with none of the patients treated with homografts (p = 0.006). During the second decade, 30-day mortality was lower (3.6% versus 22%; p = 0.007) and 5-year cumulative survival was higher (88% versus 66%; p = 0.027). Age, preoperative serum creatinine, and severe perioperative complications were independent predictors of mortality during follow-up. Conclusions. Aortic PVE is associated with a high rate of early complications and substantial early mortality. Patients who survive the immediate postoperative period have satisfactory long-term survival. The risk of recurrent endocarditis is low, especially in patients treated with homografts. The results have improved during the past decade. (C) 2016 by The Society of Thoracic Surgeons