CONGRESS ABSTRACT

Objectives: prosthetic valve endocarditis (PVE) frequently entails a periannular extension with invasion and destruction of nearby structures. Thus, surgeons are faced with challenging anatomies that often require complex surgical approaches. Herein, we report the early and midterm outcomes of a high‐risk series of patients with PVE undergoing aortic root replacement with a sub annular implantation at our center. Methods: between June 2017 and December 2024, a total of 52 patients underwent Bentall redo surgery using a sub‐annular implantation technique. Our surgical technique involves an extensive debridement of the root down to the subvalvular plane, where the new prosthesis is implanted with stiches anchoring on the intact muscular septum and on the mitral anulus. Therefore, the abscess remains open and left to drain into the pericardial cavity. Current follow up status was complete.  Results: mean age was 67±12, 39 patients were male. All patients had previously undergone aortic valve/aortic surgery and presented with active infective endocarditis. The majority (n=43) had a periannular infection (such as abscess, pseudoaneurysm or mitral involvement). Severe aortic valve regurgitation was present in 54%. Eighteen patients presented with heart failure. Twenty patients underwent urgent surgery. Forty-four patients received a tissue valve and eight a mechanical one. The median size of aortic valve prosthesis was 25(19-29). In 29 cases additional interventions were required: 7 mitral valve interventions, 2 tricuspid valve repairs, 2 coronary artery bypass grafting, 18 pacemaker implants. The mean cardiopulmonary bypass time was 153±48 and the mean cross-clamp time was 117±28. Thirty-day mortality was 11.5% (n=6); all patients presented with a NYHA class 3-4 and two of them were in critical preoperative state. Permanent neurological, renal and respiratory complications were registered respectively in 8%, 19%, 31% of patients. The mean intensive care unit stay was 6.6±7.2 days. The mean hospital stay was 15±11 days. The 1-yr survival was 78%, while at four- and six-years survival was 72% and 67% respectively. Conclusion: iIn case of PVE, the need to be radical remains the cornerstone of Bentall redo surgery. Patients undergoing these complex surgeries often present with an important burden of disease, hence they are more susceptible to post-operative complications. Nonetheless, our mid-term follow-up shows encouraging survival data.