title: Composite aortic root replacement for complex prosthetic valve endocarditis: initial clinical results and long-term follow-up of high-risk patients.
abstract: BACKGROUND
  Little information is available regarding the clinical and long-term results of patients with complex prosthetic valve endocarditis (PVE) involving the aortic root who undergo root replacement based on the Cabrol or Bentall procedures.
  
  
  METHODS
  Between January 2007 and December 2011, 148 patients underwent cardiac operations for PVE. The analysis included 31 patients with complex PVE and concomitant destruction of the aortic root. Of these, 13 patients were treated by the Cabrol procedure and 18 patients by the Bentall procedure. The mean EuroSCORE for mortality was 50.7%±3.8%. Mean follow-up was 3.8±0.4 years (range, ≤8.0 years), with a total of 97 patient-years.
  
  
  RESULTS
  The observed 30-day mortality was 12.9% and 5-year survival was 75.3%. The most common cause of death was septic multiple organ failure (42.9%). Independent predictors of mortality in multivariate analyses were terminal renal failure (odds ratio [OR], 4.8; p<0.01), type 2 diabetes mellitus (OR, 4.6; p<0.01), postoperative renal failure (OR, 4.0; p<0.01), and staphylococcal infection (OR, 2.1; p=0.01). The prevalence of freedom from reinfection was 100.0% and that from valve-related events was 93.5%.
  
  
  CONCLUSIONS
  Complex PVE is associated with quite high mortality and morbidity. Composite aortic root replacement provided good clinical and long-term outcomes as well as a low prevalence of reinfection and valve-related events. These results seem not to be inferior to those reported for noncomplex PVE. If the Bentall "button" technique was not feasible, the Cabrol procedure also provided excellent results.
authors.affiliation: Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany. manuel.wilbring@gmail.com
authors.forename: Manuel
authors.initials: M
authors.lastname: Wilbring
authors.forename: Sems Malte
authors.initials: SM
authors.lastname: Tugtekin
authors.forename: Konstantin
authors.initials: K
authors.lastname: Alexiou
authors.forename: Klaus
authors.initials: K
authors.lastname: Matschke
authors.forename: Utz
authors.initials: U
authors.lastname: Kappert
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D059905:Endocarditis, Non-Infective / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome