Treatment of Extensive Aortic Valve Endocarditis with The Freestyle Bioprosthesis, a Midterm Evaluation

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Objective: Infective aortic valve endocarditis can lead to destruction of the aortic valve and perivalvular apparatus, requiring reconstruction with a reliable and versatile prosthesis. Due to limited availability of homografts, the Medtronic Freestyle porcine aortic root bioprosthesis is often used. There is, however, limited data on the outcome of this strategy. We therefore aim to evaluate the outcome of the Freestyle bioprosthesis in the surgical management of extensive aortic valve endocarditis. Methods: Between 2002 and 2017, 66 patients received a Freestyle prosthesis at the University hospitals of Leuven for infectious endocarditis. Data was collected retrospectively, with complete follow-up and mean follow-up of 4.2 years. Major adverse end points (mortality, recurrence of endocarditis, structural valve degeneration and reoperation) were analysed. Results: The mean age at the time of operation was 64 ± 15.5 years. The mean Euroscore II was 22.2 ± 16.6, reflecting the high-risk population, moreover 12.1% (8/66) were in critical preoperative state. The indication for surgery was prosthetic valve endocarditis for 66.7% (44/66). Implantation techniques were subcoronary implantation 30.3% (20/66) and full root replacement 69.7% (46/66). Perivalvular abcedation was present in 89.4% (59/66) and 19.7% (13/66) had total root dehiscence. In-hospital mortality was 13.6% (9/66). Overall survival at 3 and 5 years was 73% (48/66) and 57% (29/51), respectively. Freedom from recurrent endocarditis at 6 years was 97%, and freedom from reoperation 95.5%. Echocardiographic follow-up did not reveal hemodynamically significant structural valve degeneration, although two patients developed a pseudo aneurysm in the aortic root which was stable in time. Conclusions: This study shows that the Freestyle aortic root porcine bioprosthesis is a reliable option with good short- and mid-term results in the treatment of aortic valve endocarditis. Longer follow-up is needed to show a potential advantage in durability compared to aortic homografts. KEYWORD: e-PD-29 The authors do not declare any conflict of interest.

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