Redo aortic root replacement for acute infective endocarditis: A tension-free proximal suturing technique.

Objectives: Acute infective endocarditis after aortic root replacement is challenging. Peri-annular complications are often present and worsen the prognosis due to the risk of aortic root dehiscence. We perform a modified Bentall procedure with a tension-free proximal suturing technique. The aim of this study was to describe the results of this technique in terms of mortality, reintervention and endocarditis recurrence.

Methods: We retrospectively analysed the data of 20 patients undergoing surgery for acute infective endocarditis on aortic root replacement between 2014 and 2021. The surgical technique involved a graft with pseudosinuses and an aortic valve prosthesis sutured to this tube, keeping 5 mm of the tube under the prosthesis, allowing tension-free suturing between the reconstructed aortic annulus and the graft. Primary end-points were overall mortality and reintervention at 1 year.

Results: The median age was 57.9 years (26.0-77.0), 80.0% patients were men, and mean EuroSCORE II was 36.0% (± 17.7). Thirteen patients (65.0%) had periannular complications, 5 patients (25.0%) had severe aortic regurgitation. At 30 days, the overall mortality rate was 10.0% (2 patients). The Kaplan-Meier survival estimates at 1-year and 6-years were 90.0% and 85.0%, respectively. During a mean 42-month (± 44.5) follow-up period, no recurrence of endocarditis or reintervention was observed. Two patients experienced Bentall dehiscence without need for reintervention.

Conclusions: The use of a modified Bentall technique with tension-free proximal suturing yields encouraging outcomes for patients undergoing redo aortic root replacement for acute infective endocarditis.