Surgery for Bentall endocarditis: short- and midterm outcomes from a multicentre registry

Sandro Sponga*, Michele Di Mauro, Pietro G. Malvindi, Domenico Paparella, Giacomo Murana, Davide Pacini, Luca Weltert, Ruggero De Paulis, Giangiuseppe Cappabianca, Cesare Beghi, Carlo De Vincentiis, Alessandro Parolari, Antonio Messina, Giovanni Troise, Antonio Salsano, Francesco Santini, Michele D. Pierri, Marco Di Eusanio, Daniele Maselli, Guglielmo Actis DatoPaolo Centofanti, Samuel Mancuso, Mauro Rinaldi, Giuseppe Cagnoni, Carlo Antona, Marco Piciche, Loris Salvador, Diego Cugola, Lorenzo Galletti, Alberto Pozzoli, Michele De Bonis, Roberto Lorusso, Uberto Bortolotti, Ugolino Livi, Italian Group of Research for Outcome in Cardiac Surgery (GIROC)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)

Abstract

OBJECTIVES: Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis.

METHODS: Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 +/- 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%.

RESULTS: Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30months (1-221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9-219)]. Survival at 5 and 8 years was 75 +/- 6% and 71 +/- 7%, with 3 cases of endocarditis relapse.

CONCLUSIONS: Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.

[GRAPHICS]

Original languageEnglish
Pages (from-to)839-846
Number of pages8
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume58
Issue number4
DOIs
Publication statusPublished - Oct 2020
Event33rd European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting - Lisbon, Portugal
Duration: 3 Oct 20195 Oct 2019

Keywords

  • Endocarditis
  • Bentall procedure
  • Aortic valve
  • Aortic surgery
  • Aortic root
  • AORTIC ROOT REPLACEMENT
  • TERM-FOLLOW-UP
  • PROSTHETIC VALVE ENDOCARDITIS
  • INFECTIVE ENDOCARDITIS
  • SURGICAL-TREATMENT
  • ASCENDING AORTA
  • GRAFT
  • MANAGEMENT

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