gms | German Medical Science

Introduction: Little information exists regarding the clinical and long-term results of patients suffering from complex prosthetic valve endocarditis (PVE) involving the aortic root, undergoing Cabrol- or Bentall root replacement.

Material and methods: Between January 2007 and December 2011 148 patients underwent cardiac surgery due to PVE. The analysis included 31 patients with complex PVE and concomitant destruction of the aortic root. Out of these, 13 patients were treated with a Cabrol- and 18 patients with a Bentall-procedure. The mean euroSCORE for mortality was 50.7±3.8%. Mean follow up time was 3.8±0.4 years, ranging up to 8.0 years with a total of 97 patient-years

Results: The observed 30-day mortality was 12.9%. The five-year survival was 75.3%. Most common cause for death was septic multiorgan failure (42.9%). Independent predictors of mortality in multivariate analysis were terminal renal failure (OR 4.8; p<0.01), Diabetes mellitus type 2 (OR 4.6; p<0.01), postoperative renal failure (OR 4.0; p<0.01) and staphylococcal infection (OR 2.1; p=0.01). Freedom from reinfection was 100.0%, freedom from valve related events 93.5%.

Conclusion: Complex PVE is associated with quite high mortality and morbidity. Composite aortic root replacement provided good clinical and long-term outcome, low rates of reinfection and valve-related events. The achieved results seemed to be not inferior to those reported for noncomplex PVE. If Bentall “button”-technique was not feasible, Cabrol-technique also provided excellent results.