Contributors: Sponga, S.; Di Mauro, M.; Malvindi, P. G.; Paparella, D.; Murana, G.; Pacini, D.; Weltert, L.; De Paulis, R.; Cappabianca, G.; Beghi, C.; De Vincentiis, C.; Parolari, A.; Messina, A.; Troise, G.; Salsano, A.; Santini, F.; Pierri, M. D.; Di Eusanio, M.; Maselli, D.; Actis Dato, G.; Centofanti, P.; Mancuso, S.; Rinaldi, M.; Cagnoni, G.; Antona, C.; Piciche, M.; Salvador, L.; Cugola, D.; Galletti, L.; Pozzoli, A.; De Bonis, M.; Lorusso, R.; Bortolotti, U.; Livi, U.
نبذة مختصرة : OBJECTIVES: Endocarditis after the Bentall procedure is a severe disease often complicated by a pseudoaneurysm or mediastinitis. Reoperation is challenging but conservative therapy is not effective. The aim of this study was to assess short- and midterm outcomes of patients reoperated on for Bentall-related endocarditis. METHODS: Seventy-three patients with Bentall procedure-related endocarditis were recorded in the Italian registry. The mean age was 57 ± 14 years and 92% were men; preoperative comorbidities included hypertension (45%), diabetes (12%) and renal failure (11%). The logistic EuroSCORE was 25%; the EuroSCORE II was 8%. RESULTS: Preoperatively, 12% of the patients were in septic shock; left ventricular-aortic discontinuity was present in 63% and mitral valve involvement occurred in 12%. The most common pathogens were Staphylococcus aureus (22%) and Streptococci (14%). Reoperations after a median interval of 30 months (1-221 months) included a repeat Bentall with a bioconduit (41%), a composite mechanical (33%) or biological valved conduit (19%) and a homograft (6%). In 1 patient, a heart transplant was required (1%); in 12%, a mitral valve procedure was needed. The hospital mortality rate was 15%. The postoperative course was complicated by renal failure (19%), major bleeding (14%), pulmonary failure (14%), sepsis (11%) and multiorgan failure (8%). At multivariate analysis, urgent surgery was a risk factor for early death [hazard ratio 20.5 (1.9-219)]. Survival at 5 and 8 years was 75 ± 6% and 71 ± 7%, with 3 cases of endocarditis relapse. CONCLUSIONS: Surgery is effective in treating endocarditis following the Bentall procedure although it is associated with high perioperative mortality and morbidity rates. Endocarditis relapse seems to be uncommon.
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