Aortic homografts for native and prosthetic aortic valve and root endocarditis: Results from the EUropean REgistry of Cryopreserved Aortic Homografts EURECAH.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42190794.
- Also identified by DOI 10.1016/j.jtcvs.2026.05.011.
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Abstract
To report the early and late results of patients treated with an aortic homograft for complex aortic native and prosthetic valve endocarditis. Clinical data of patients undergoing aortic valve/root replacement with an aortic homograft for infective endocarditis from 2000 to 2025 in 5 European cardiac centers were collected in the EUropean REgistry of Cryopreserved Aortic Homografts (EURECAH) and retrospectively analyzed. Follow-up data were collected until December 2025. In total, 544 patients, 78% of whom were male, with a median age of 65 [54-73] years, have been enrolled in the EURECAH, including 188 (35%) with native and 356 (65%) with prosthetic valve endocarditis complicated by 369 (68%) annular abscess, 187 (34%) mitroaortic discontinuity, 84 (15%) mitral valve, and 24 (4%) right-sided endocarditis. Aortic homografts were implanted with full root (85%), freehand subcoronary (11%), and the inclusion technique (4%). Median cardiopulmonary bypass time was 192 [150-239] minutes and aortic crossclamping time was 147 [115-182] minutes. In total, 247 (45%) patients died during follow-up, including 85 (15%) periprocedural, 32 (6%) early and 130 (24%) late deaths. Median survival time was 10.2 [1.9-19.8] years. Overall survival rates were 87.9% at 30 days, 78.5% at 1 year, 67.1% at 5 years, and 52.8% at 10 years. In total, 77 (14%) patients underwent reintervention for structural valve dysfunction (6%), infective endocarditis (3%), nonstructural valve dysfunction (1%), mitral valve regurgitation (2%), coronary artery disease (1%), heart transplantation (1%), and aortic aneurysm (1%). The results of the EURECAH registry show that the use of an aortic homograft for native and prosthetic aortic valve and root endocarditis is safe and provides satisfactory early and late survival despite the complexity of the condition, with good long-term durability and low rates of recurrent endocarditis.