title: Root replacement with stentless Freestyle bioprostheses for active endocarditis: a single centre experience.
abstract: OBJECTIVE
  Few studies have examined the use of stentless Freestyle bioprostheses in patients with active valve endocarditis (VE). The aim of this study was to evaluate outcomes of stentless Freestyle bioprostheses in patients undergoing full-root replacement.
  
  
  METHODS
  From February 2000 to June 2010, 180 patients with VE underwent cardiac surgery at our institution, of which 71 (39.5%) had prosthetic VE. Eighteen patients underwent full-root replacement with Freestyle bioprostheses: 3 patients (16%) had native aortic VE, 14 (78%) had aortic prosthetic VE and 1 (6%) had mitral and aortic prosthetic VE. Mean age was 66.7 ± 10.1, M/F: 6/12, mean logistic EuroSCORE 36.4 ± 21.6. Eight patients (42%) underwent concomitant procedures (two mitral valve replacements, three ascending aorta replacements, one coronary artery bypass grafting (CABG), one ventricular septal disease (VSD) repair, one CABG + ascending aorta + VSD repair).
  
  
  RESULTS
  Two patients (11%) died in-hospital. At the median follow-up of 24 months (range 1-113 months), no death occurred and freedom from reoperation was 87.5% (2 patients for aortic root pseudo-aneurysm at 1 and 23 months). All patients are in NYHA functional class I and have satisfactory echocardiographic data (EF 54.3 ± 8%, peak and mean trans-prosthetic gradients 12 ± 6.7 mmHg and 7.5 ± 3.6 mmHg) with 100% freedom recurrence of VE.
  
  
  CONCLUSIONS
  Our experience shows that root replacement with Freestyle stentless bioprostheses in patient with VE, is associated with low rates of early and mid-term mortality, good haemodynamic performance and low rates of valve-related morbidity as well as low recurrence of infection.
authors.affiliation: Department of Cardiac Surgery, Fondazione Toscana G. Monasterio' Massa, Pisa, Italy. antoniomiceli79@alice.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Miceli
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Croccia
authors.forename: Simone
authors.initials: S
authors.lastname: Simeoni
authors.forename: Egidio
authors.initials: E
authors.lastname: Varone
authors.forename: Michele
authors.initials: M
authors.lastname: Murzi
authors.forename: Pier Andrea
authors.initials: PA
authors.lastname: Farneti
authors.forename: Marco
authors.initials: M
authors.lastname: Solinas
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D004739:England; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography