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Full-root aortic valve replacement using Medtronic Freestyle bioroots for infective endocarditis

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Title: Full-root aortic valve replacement using Medtronic Freestyle bioroots for infective endocarditis
Authors: Emilien Philippe Ruchonnet, Laura Didisheim, Matthaios Papadimitriou-Olivgeris, Pierre Monney, Lars Niclauss, René Prêtre, Matthias Kirsch, Ziyad Gunga
Source: Interdiscip Cardiovasc Thorac Surg
Interdisciplinary cardiovascular and thoracic surgery, vol. 40, no. 3
Publisher Information: Oxford University Press (OUP), 2025.
Publication Year: 2025
Subject Terms: Male, Heart Valve Prosthesis Implantation, Reoperation, Adult, Prosthesis-Related Infections, Time Factors, Endocarditis, Bacterial, Middle Aged, Prosthesis Design, Treatment Outcome, Valvular Heart Disease, Aortic Valve, Heart Valve Prosthesis, Humans, Retrospective Studies, Aged, Female, Aortic Valve/surgery, Heart Valve Prosthesis Implantation/instrumentation, Heart Valve Prosthesis Implantation/adverse effects, Heart Valve Prosthesis Implantation/methods, Heart Valve Prosthesis/adverse effects, Endocarditis, Bacterial/surgery, Endocarditis, Bacterial/microbiology, Endocarditis, Bacterial/mortality, Prosthesis-Related Infections/surgery, Prosthesis-Related Infections/microbiology, Replantation/methods, Risk Factors, Endocarditis/surgery, Endocarditis/mortality, Freestyle, abscess, endocarditis
Description: OBJECTIVES This study aims to explore the potential efficacy of the Freestyle Medtronic bioroot in the treatment of aortic endocarditis, based on our single-centre experience. METHODS In this retrospective study conducted between 2015 and 2023, adult patients who underwent aortic root replacement with coronary arteries reimplantation using the modified Bentall technique with a Medtronic Freestyle bioroot in our centre for infective endocarditis were included. RESULTS Thirty patients, with five deaths, no cases of relapse and two cases of reinfection, were included, and prosthetic valve endocarditis represented 73.3% of cases. The median age was 66 years (IQR 14.5 years), and 24/30 (80%) were male. Median EuroSCORE II was 12.2% (IQR 13.9%). The most commonly identified pathogen was Staphylococcus aureus (eight cases; 23.3%). Fourteen additional procedures were performed on 12 patients. Annular abscess was present in 73.3% of cases and required annulus patch repair in 13/22 (59%). Early reoperation rate was 20%, mostly for surgical bleeding. One- and 5-year actuarial survival rates were 90.0 and 82.2%, respectively. There were no cases of relapse, and reinfection-free survival was 86.7% at 1 year and 75.5% at 5 years. Postoperative mean and maximal transvalvular gradients were 7 (IQR 3.3 mmHg) and 14.6 mmHg (IQR 4.6 mmHg), respectively. CONCLUSIONS The Medtronic Freestyle bioroot could be a valid alternative to homografts for the treatment of infective endocarditis, particularly in cases necessitating aortic root reconstruction after extensive debridement of annular abscesses, with comparable outcomes and potential advantages in terms of durability and availability.
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 2753-670X
DOI: 10.1093/icvts/ivaf034
Access URL: https://pubmed.ncbi.nlm.nih.gov/40036310
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https://serval.unil.ch/resource/serval:BIB_AA100E1030C7.P001/REF.pdf
Rights: CC BY NC
URL: http://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
Accession Number: edsair.doi.dedup.....046a0579b684e966c4f647465af47a38
Database: OpenAIRE
Description
Abstract:OBJECTIVES This study aims to explore the potential efficacy of the Freestyle Medtronic bioroot in the treatment of aortic endocarditis, based on our single-centre experience. METHODS In this retrospective study conducted between 2015 and 2023, adult patients who underwent aortic root replacement with coronary arteries reimplantation using the modified Bentall technique with a Medtronic Freestyle bioroot in our centre for infective endocarditis were included. RESULTS Thirty patients, with five deaths, no cases of relapse and two cases of reinfection, were included, and prosthetic valve endocarditis represented 73.3% of cases. The median age was 66 years (IQR 14.5 years), and 24/30 (80%) were male. Median EuroSCORE II was 12.2% (IQR 13.9%). The most commonly identified pathogen was Staphylococcus aureus (eight cases; 23.3%). Fourteen additional procedures were performed on 12 patients. Annular abscess was present in 73.3% of cases and required annulus patch repair in 13/22 (59%). Early reoperation rate was 20%, mostly for surgical bleeding. One- and 5-year actuarial survival rates were 90.0 and 82.2%, respectively. There were no cases of relapse, and reinfection-free survival was 86.7% at 1 year and 75.5% at 5 years. Postoperative mean and maximal transvalvular gradients were 7 (IQR 3.3 mmHg) and 14.6 mmHg (IQR 4.6 mmHg), respectively. CONCLUSIONS The Medtronic Freestyle bioroot could be a valid alternative to homografts for the treatment of infective endocarditis, particularly in cases necessitating aortic root reconstruction after extensive debridement of annular abscesses, with comparable outcomes and potential advantages in terms of durability and availability.
ISSN:2753670X
DOI:10.1093/icvts/ivaf034