• Jeffrey Clemence, Juan Caceres, Tom Ren, Xiaoting Wu, Karen M Kim, Himanshu J Patel, G Michael Deeb, and Bo Yang.
• Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
• J. Thorac. Cardiovasc. Surg. 2022 Aug 1; 164 (2): 480487.e1480-487.e1.

ObjectiveThe study objective was to provide evidence for choosing a bioprosthesis in treating patients with active aortic valve endocarditis.MethodsFrom 1998 to 2017, 265 patients with active aortic valve endocarditis underwent aortic valve replacement with a stented valve (n = 97, 37%) or a stentless valve (n = 168, 63%) with further breakdown into inclusion technique (n = 142, 85%) or total root replacement (n = 26, 15%). Data were obtained from the Society of Thoracic Surgeons database aided with chart review, surveys, and National Death Index data.ResultsThe median age of patients was 53 years (43-56) in the stented group and 57 years (44-66) in the stentless group. The stented and stentless groups had high rates of heart failure (54% and 40%), liver disease (16% and 7.7%), prosthetic valve endocarditis (14% and 48%), root abscess (38% and 70%), and concomitant ascending aorta procedures (6.2% and 22%), respectively. The stentless group required permanent pacemakers in 11% of cases. Operative mortality was similar between groups (6.2% and 7.1%). The 5-year survival was 52% and 63% in the stented and stentless groups, respectively. Significant risk factors for long-term mortality included liver disease (hazard ratio, 2.38), previous myocardial infarction (hazard ratio, 1.64), congestive heart failure (hazard ratio, 1.63), and renal failure requiring dialysis (hazard ratio, 4.37). The 10-year cumulative incidence of reoperation was 12% and 3.4% for the stented and stentless groups, respectively. The 10-year freedom from reoccurrence of aortic valve endocarditis was 88% for the stented and 98% for the stentless groups.ConclusionsBoth stented and stentless aortic valves are appropriate conduits for replacement of active aortic valve endocarditis for select patients.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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