Surgical treatment of active aortic endocarditis: Homografts are not the cornerstone of outcome

Background. Surgical treatment of active aortic infective endocarditis is challenging, and the type of prosthesis to be implanted during the active phase remains controversial. Methods. All consecutive patients with definite diagnosis of aortic infective endocarditis operated on during the active phase were included. Endpoints were in-hospital mortality and a combined end point including infective endocarditis recurrence, prostheses dysfunction, or long-term cardiovascular mortality. Results. Among 127 consecutive patients, mean age 57 +/- 15 years, 87% male, 30% with preexisting aortic prosthesis, and 63 (50%) with annulus abscess, 54 (43%) were treated with aortic homograft and 73 (57%) with conventional prosthesis. Median time between diagnosis and surgery was 10 days. In-hospital mortality was 9%, not different between homograft and conventional prostheses (11% versus 8%, p = 0.6). By multivariable analysis, prosthetic valve endocarditis (8.5 [95% confidence interval: 2.2 to 33.6], p = 0.001) was the only variable independently associated with in-hospital mortality, which was not influenced by type valvular substitute (p = 0.6), even in the subset with annulus abscess (p = 0.2). Ten-year survival free from the combined endpoint was 44% +/- 10%, not different between homograft and conventional prostheses (log rank p = 0.2). By multivariable analysis, comorbidity index (2.6 [1.05 to 6.3], p = 0.04) and prosthetic valve endocarditis (2.3 [1.2 to 4.6], p = 0.02) were independently predictive of the combined endpoint, which was not determined by type of valvular substitute (p = 0.6) even in the subset with annulus abscess (p = 0.5). Conclusions. Implantation of conventional prostheses during the active phase of aortic endocarditis yields similar low operative mortality and long-term prognosis as compared with aortic homografts, even in patients with annulus abscess.