The Role of Mentorship and Homograft Repair for Endocarditis with
Complex Aortic Root Abscess
Abstract
Background: Aortic root abscess surgery has significant mortality but
can be performed safely by trainees supervised by senior surgeons.
Methods: Between 2007 and 2017, 54 consecutive patients (mean 64 years
old) with active aortic endocarditis complicated with periannular
abscess underwent aortic root replacement with homograft. Twenty-eight
cases (52%) in which postgraduate year 5-8 residents or junior
attending surgeons performed under senior attending supervision were
compared to 26 cases the senior attending performed. Mean follow-up was
2.2 years. Results: Forty-three patients (80%) had previous aortic
valve replacement and 26 (48%) were in New York Heart Association class
III or IV status. Forty-two patients (78%) had concomitant procedure
including 20 (37%) aorto-mitral curtain reconstruction and 6 (11%)
hemi aortic arch replacement under circulatory arrest. Median cross
clamp time was 218 minutes. There was no operative mortality. One
patient (2%) had re-exploration for bleeding and 3 (6%) had stroke.
Median hospital stay was 10 days. Preoperative characteristics and short
and mid-term results were all comparable between mentee cases vs senior
attending cases. Survival at 6 years were 67.3% (95% CI 38.0 –
85.0%) in mentee cases and 75.6% (95% CI 47.1 – 90.1%) in senior
attending cases (adjusted hazard ratio 1.48, 95% CI 0.33- 6.73,
P=0.61). During follow up, 2 patients (3.7%) required reoperation on
the aorta valve for structural valve deterioration and 1 (1.8%) had
recurrent endocarditis. Conclusions: Homograft aortic root replacement
can be performed safely by trainees with an experienced surgeon showing
favorable outcomes, midterm survival, and freedom from recurrent
endocarditis.