Letter:
To the Editor:
We have read the article ”Long-term results of aortic root replacement
for endocarditis” by Charles M. Wojnarski et al.1 with
a general interest. We commend the authors for their outstanding
efforts. We concede with the definitive conclusion that aortic root
replacement for IE can be accomplished with tolerable risk and the same
long-term survival as a root replacement for other reasons when
stentless prostheses are aggressively utilized. The choice between a
homograft and a porcine stentless conduit did not affect long-term
survival. In cases of endocarditis, bioprosthetic root replacement with
homograft or stentless bioprosthetic root has 10-year durability that is
exceptional. However, we’d like to bring up a few extra points to
discuss other aspects that may have increased the study’s scope.
Firstly, the risk of recollection bias and incorrect patient
recordkeeping has raised various issues about this type of study, which
may have been addressed if the authors had included current cases.
Furthermore, a study in a specific place may introduce bias due to
socioeconomic, health, and environmental differences. Furthermore, the
tiny sample size, which determines the study’s power, raises serious
issues about the study’s accuracy. Aortic root replacement for
prosthetic aortic valve infection accompanied by aortic root destruction
is an established surgical procedure. However, there is no comparison in
this study between the use of prosthetic material and allogeneic
material. For instance, Rainer G. Leyh et al.2concluded that the material utilized for aortic root restoration in PVE
with viral aortic root damage has no significant impact on postoperative
outcomes. The approach of early reoperation for PVE, comprehensive
debridement, aggressive surgical technique, and prolonged antibiotic
therapy may minimize mortality and the frequency of early and late
recurrent PVE and increase long-term survival. The pathogenesis of
prosthetic endocarditis is characterized by worsening tissue perfusion
due to aortic regurgitation and uncontrolled bacteremia. These
individuals had an acute left ventricular failure, septic embolization
of the system, and aortic regurgitation. The incidence rate of this
illness ranges from 0.5% to 2%, with a 60% to 86% death rate among
patients with S. aureus-caused premature prosthetic endocarditis. The
benefits of homograft are that it enables a regionally flowing
hemodynamic circulation, excludes the weakened and infected aortic
annulus from the high systemic pressures, in some cases widens the left
ventricular outflow, and permits the novel prosthesis to be sutured at
the aortic root bed in cohesion with better and healthier
myocardium.3
Traditionally, IE was treated using an aortic valve homograft. It
enables radical debridement of contaminated tissues and rebuilding of
the left ventricular outflow tract or anterior mitral cusp. The absence
of foreign material minimizes the likelihood of reinfection. Due to the
restricted availability of homografts in critical cases and structural
valve degradation, reoperations are challenging. The modified Bentall
method is used to insert mechanical and biological conduit valves.
Because of their immediate availability in all sizes and uniform
insertion techniques, these are widely employed as aortic root
replacements, not just for endocarditis.4