"Aortic valve surgery in patients with infective endocarditis: mid-term follow-up of patients treated with the St. Jude medical trifecta(r) valve"

Abstract

Abstract Background: Despite recent ongoing efforts, there is still no ideal prosthetic valve substitute. It is particularly difficult to choose the appropriate prosthesis to treat infective endocarditis. Objectives: Investigate the outcomes after aortic valve replacement with a stented bioprosthesis (Trifecta) in patients with active or previous infective endocarditis. Methods: We performed a single-centre, retrospective and descriptive study including consecutive patients with infective endocarditis who underwent Aortic valve replacement between July 2011 and June 2019. Survival and reintervention were checked in December 2021. The median follow-up time was 5.6 years and the maximum was 10 years. According to the type of data, mean and median (minimum and maximum) and absolute or relative frequencies were used for sample characterisation and to describe early outcomes. Hospital mortality was defined as in-hospital-death or within 30-days after surgery. Kaplan-Meier method was used for time-to-event outcomes assessment (all-causes mortality and reoperation). Results: We included 48 patients, median age of 70 (40 to 87) years, 81% male. Most patients (74%) had native valve infective endocarditis and 17% had previous endocarditis. Surgery was urgent in 75%. Hospital mortality occurred in 9 patients (19%). After excluding these patients, 1-, 3-, 6-, and 9-years cumulative survival rates were 92%, 80%, 73%, and 73%, respectively. There were five bioprosthesis-related reoperations: 4 due to endocarditis at 1-year, 3-years, and 5-years (n=2) of follow-up and 1 due to nonstructural deterioration 6-years post-operative. Conclusions: Although the small sample size, this report supports a satisfactory performance profile of the Trifecta in the treatment of infective endocarditis.