Objectives: This study examined the incidence and outcomes of contemporary surgery for active native (NVE) and prosthetic aortic valve endocarditis (PVE).
Methods: The data of all patients undergoing surgery for active aortic endocarditis between 2006 and 2014 were reviewed. Prespecified endpoints of analyses included composite morbidity, recurrent endocarditis and survival-outcomes.
Results: 22 patients were operated during a 9-year period. Mean age was 55.9±15 years. The distribution of NVE and PVE was 59% and 41%. The most common infecting microorganisms for NVE were streptococcal and staphylococ aureus species (39% each) and staphylococ coagulase negative for PVE (89%). In PVE patients the prior valve was biological in 66% of patients. Echocardiographic severe aortic regurgitation was evident in 62% of patients (NVE, 46%; PVE, 10%) and indication for surgery was urgent/emergent in 18%. Extraanular extension (in form of perivalvular abscess) was limited to PVE and occurred in 22%. Subsequent root procedures were required in three PVE patients (33%) (root replacement 22%, patch reconstruction 11%). Biological prosthesis was implanted in 72% of patients (NVE, 69%; PVE, 77%) and additional mitral procedures were performed in 32%.
Overall 30-day mortality was 9.1% (7.6% and 11% for NVE and PVE respectively, p=0.7). At 8 years, freedom from all-cause mortality, freedom from recurrent endocarditis and freedom from reoperation was 77%, 86% and 95% respectively (Kaplan-Meier).
Conclusions: Surgery for aortic endocarditis remains challenging and associated with high operative mortality. Nevertheless, survivors face favorable long-term outcome and low propensity for endocarditis recurrence.
