• Yuji Morishima, Tadao Kugai, Katsuhito Mabuni, Noriyuki Abe, and Takahiro Yamazato.
• Department of Cardiovascular Surgery,Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, Okinawa, Japan.
• Kyobu Geka. 2014 May 1; 67 (5): 347-52; discussion 352-5.

AbstractTreatment of infective endocarditis (IE) associated with aortic annular destruction remains a formidable surgical challenge. Discussions about the optimum modality for reconstruction are still continuing. In such severe endocarditis, we have performed aortic root replacement using the Freestyle stentless bioprosthesis with the full root technique. From 2005 through 2012, 11 patients who had aortic valve endocarditis with annular destruction underwent aortic root replacement at our institute. All of them were treated with the Freestyle stentless bioprosthesis. Their mean age was 69.9 years, and 8 patients were men. Two patients had native valve endocarditis and 9 patients had prosthetic valve endocarditis. Despite appropriate antibiotic therapy, 3 patients required emergency surgery because of hemodynamic deterioration. In-hospital death occurred in 1 patient due to progressive hemodynamic failure. The 10 hospital survivors were followed up for a mean of 27.7±23.1 months (range 5 to 82). Although late death occurred in 2 patients, recurrent IE was not observed in any patients during the follow-up. The results of our study suggest that the Freestyle stentless bioprosthesis could be an excellent alternative to a homograft in the treatment of infective endocarditis associated with aortic annular destruction.

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