Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis

Abstract Background The ideal surgical reconstruction of the aortic root in patients with complex endocarditis is controversial. We compare the short- and long-term outcomes between mechanical valves, bioprostheses and homografts. Methods We identified all patients undergoing surgery for active complex aortic endocarditis at our institution between 2003 and 2017. We grouped patients into those who received a mechanical valve, bioprosthesis, or homograft. We used multiple logistic regression and proportional hazards models. To minimize confounding by indication, we used marginal risk-adjustment to simulate that every patient would undergo (contrary to fact) all 3 operations. Results Of 159 patients with complex active endocarditis, 48(30.2%) had a valve+patch reconstruction, and 85 (53.4%) had a root replacement. Of all, 50(31.5%) had a mechanical valve, 56 (35.2%) had a bioprosthesis, and 53 (33.3%) had a homograft. The groups were similar in age, sex, BMI, comorbid conditions, organism, abscess location and mitral involvement (all p>0.05). However, patients receiving mechanical reconstructions were more likely to have native valve endocarditis (46% vs 37.5% vs 17%; p=0.005) and less likely to undergo root replacement 32% vs 28.6% vs 100%; p Conclusions In patients with complex endocarditis, mechanical valves are associated with similar, if not better, short- and long-term outcomes when compared to homografts, even after adjusting for important baseline characteristics and limiting the analysis to root replacements only.