Single-center experience with all-biological valved conduit for the treatment of complex aortic root endocarditis

Objective: Despite advancement in medical and surgical treatment, endocarditis involving the aortic root still represents a challenge for the cardiac surgeon due to the anatomic complexity and fundamental function of the aortic root itself. The purpose of this research is to assess outcomes from one center's experiences of implementing the BioIntegral conduit for patients who have undergone both aortic root and aortic valve replacement due to complex aortic root infective endocarditis. Methods: From February 2011 to December 2023, 46 patients underwent BioIntegral valved conduit implantation at our institution. The mean age of our population was 67.6 years (±9.3 years), and the primary surgical indication was severe active endocarditis involving the aortic root. The mean European System for Cardiac Operative Risk Evaluation II was 25.6 (±15.8). We evaluated 30-day mortality, overall survival, and freedom from reoperation as end points of our analysis using t tests, chi-square tests, Cox regression, and Kaplan–Meier analyses. Results: Six patients died during hospital stay (13.0%), and the reported 30-day mortality was 8.2% (4 patients). The Cox regression analysis performed to evaluate the impact of both risk factors and intraoperative attributes on the 30-day mortality rate showed that the variables related to increased 30-day mortality were European System for Cardiac Operative Risk Evaluation II (P = .045), older age, and cardiopulmonary bypass time. On Kaplan–Meier analysis, the overall survival at 1 and 3 years was 87.0%, whereas freedom from reoperation for graft dysfunction was 100% and at 1 and 3 years. Conclusions: Despite the small sample size, our results indicate favorable long-term survivals and minimal need for reoperation with the BioIntegral conduit. This conduit demonstrated positive outcomes even in patients with complex surgical histories and severe aortic root and valve endocarditis. Although promising, these results warrant further investigation with larger patient groups to confirm their broader applicability.