title: Freestyle root replacement for complex destructive aortic valve endocarditis.
abstract: OBJECTIVE
  In destructive aortic valve endocarditis with abscess formation in the root, homografts are used more often than xenografts. Because we had reliable perioperative results with Freestyle (Medtronic Inc, Minneapolis, Minn) xenograft root replacement in these complex patients, we analyzed the long-term outcome in this high-risk indication.
  
  
  METHODS
  Of 126 consecutive patients with aortic valve endocarditis treated by surgery from 1997 to 2012, 32 (25.4%) received a Freestyle aortic root replacement for severe, destructive valve endocarditis and were studied retrospectively with approval of the local ethical committee. Perioperative complications, recurrence of endocarditis, and long-term morbidity and mortality were analyzed. The follow-up period was 3 months to 11.5 years.
  
  
  RESULTS
  Indication for surgery was native (n = 9) and prosthetic valve endocarditis (n = 23). In 18 patients, concomitant procedures were performed: coronary bypass (n = 9), additional valve surgery (n = 6), and ascending aortic surgery (n = 7). Thirty-day mortality was 19.4% (n = 6). There were no instances of technical failure requiring modification of the surgical strategy or reoperation for anastomotic bleeding. Actuarial survival at 5 and 10 years was 61.9% and 54.2%, respectively. Freedom from death, reoperation for prostheses dysfunction, and recurrence of endocarditis as the composite end point at 5 and 10 years was 56.3% and 53.1%, respectively.
  
  
  CONCLUSIONS
  The Freestyle root was used successfully with no technical complications in all patients with most severe destructive aortic root endocarditis. In view of this complex patient population, short- and long-term results make this conduit a reliable choice for treatment of this condition.
authors.affiliation: Department of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Anneliese
authors.initials: A
authors.lastname: Heinz
authors.affiliation: Department of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Dumfarth
authors.affiliation: Department of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann-Ulmer
authors.affiliation: Department of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.affiliation: Department of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria. Electronic address: ludwig.mueller@i-med.ac.at.
authors.forename: Ludwig C
authors.initials: LC
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D004696:Endocarditis / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult