Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis. Journal Article

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Authors: Abdelsattar, ZM; Elsisy, MF; Schaff, H; Stulak, J; Greason, K; Pochettino, A; Arghami, A; Rowse, P; Bagameri, G; Khullar, V; Daly, R; Cicek, S; Dearani, J; Crestanello, J
Article Title: Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis.
Abstract: BACKGROUND: The ideal surgical reconstruction of the aortic root in patients with complex endocarditis is controversial. We compare the short- and long-term outcomes between mechanical valves, bioprostheses and homografts. METHODS: We identified all patients undergoing surgery for active complex aortic endocarditis at our institution between 2003 and 2017. We grouped patients into those who received a mechanical valve, bioprosthesis, or homograft. We used multiple logistic regression and proportional hazards models. To minimize confounding by indication, we used marginal risk-adjustment to simulate that every patient would undergo (contrary to fact) all 3 operations. RESULTS: Of 159 patients with complex active endocarditis, 48(30.2%) had a valve+patch reconstruction, and 85 (53.4%) had a root replacement. Of all, 50(31.5%) had a mechanical valve, 56 (35.2%) had a bioprosthesis, and 53 (33.3%) had a homograft. The groups were similar in age, sex, BMI, comorbid conditions, organism, abscess location and mitral involvement (all p>0.05). However, patients receiving mechanical reconstructions were more likely to have native valve endocarditis (46% vs 37.5% vs 17%; p=0.005) and less likely to undergo root replacement 32% vs 28.6% vs 100%; p0.001. Marginal risk-adjusted operative mortality was lowest for mechanical valves (4.8%) and highest for homografts (16.9%; p=0.041). Long-term survival after root replacement was worse with homografts compared to mechanical valve conduits (aHR=2.9; p=0.045). CONCLUSIONS: In patients with complex endocarditis, mechanical valves are associated with similar, if not better, short- and long-term outcomes when compared to homografts, even after adjusting for important baseline characteristics and limiting the analysis to root replacements only.
Journal Title: The Annals of Thoracic Surgery
ISSN: 1552-6259; 0003-4975
Publisher: Unknown  
Date Published: 2020