Background Treatment of severe necrotizing aortic root endocarditis (SNARE) carries a substantial perioperative risk. As an alternative to homografts, we assessed short-term outcome and future prognosis in patients undergoing root replacement using the Freestyle valve.

Methods Between 2000 and 2018, a total of 45 patients (mean age 70.9 ± 8.3 years, 66% men) underwent aortic root replacement for SNARE using the Freestyle valve. Mean Society of Thoracic Surgeons mortality score and EuroScore II were 22.6% ± 17.1 and 29.3% ± 20.9, respectively. Prosthetic endocarditis was present in 70.1%, and aortic annulus patch repair was performed in 64% of the patients. Median follow-up was 3.6 years (range: 0.1–14.5) and was 100% complete.

Results The 30-day mortality was 15.5%. During follow-up, there were no reoperations, while reinfection was suspected in one patient. Survival was significantly inferior to the general population with a standardized mortality ratio of 10.7 (95% confidence interval [CI]: 9.1–12.6) (p < 0.0001). In 30-day survivors and after correction for significant comorbidities in a Cox proportional hazards model, estimated survival probabilities at 1, 5, and 10 years were 98.7 (95% CI: 92.5–99.8%), 94.1 (77.9–98.5%), and 63.8 (28.4–85.2%). Estimated mean difference in survival probability was better for the general population after postoperative year 6, but within the 95% CI for no difference.

Conclusion Use of the Freestyle valve is reliable solution for the most complex cases with a low rate of reinfection. Early mortality is substantial and caused by the patient's condition and severity of the infection. Excess late mortality can be attributed to patient-specific comorbidities.

背景 严重坏死性主动脉根性心内膜炎 (SNARE) 的治疗具有很大的围手术期风险。作为同种移植的替代方案，我们评估了使用 Freestyle 瓣膜进行牙根置换术的患者的短期结果和未来预后。

方法 2000 年至 2018 年间，共有 45 名患者（平均年龄 70.9 ± 8.3 岁，66% 为男性）接受了使用 Freestyle 瓣膜的 SNARE 主动脉根置换术。胸外科医师学会死亡率评分和 EuroScore II 的平均评分分别为 22.6% ± 17.1 和 29.3% ± 20.9。70.1% 存在人工心内膜炎，64% 的患者进行了主动脉环补片修复。中位随访时间为 3.6 年（范围：0.1–14.5）并且 100% 完成。

结果 30天死亡率为15.5%。随访期间未再手术，1例疑似再感染。生存率明显低于一般人群，标准化死亡率为 10.7（95% 置信区间 [CI]：9.1–12.6）（p  < 0.0001）。在 30 天幸存者中，在 Cox 比例风险模型中对显着合并症进行校正后，1 年、5 年和 10 年的估计生存概率分别为 98.7（95% CI：92.5–99.8%）、94.1（77.9–98.5%）、和 63.8 (28.4–85.2%)。术后 6 年后，一般人群的生存概率估计平均差异更好，但在 95% CI 内表示无差异。

结论 对于再感染率低的最复杂病例，使用 Freestyle 瓣膜是可靠的解决方案。早期死亡率很高，由患者的状况和感染的严重程度引起。晚期死亡率过高可归因于患者特异性合并症。