https://doi.org/10.1177/0267659117690250 Perfusion 2017, Vol. 32(5) 383–388 © The Author(s) 2017 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0267659117690250 journals.sagepub.com/home/prf Introduction Prosthetic valve endocarditis (PVE) is a serious compli- cation after valve replacement which often requires sur- gical management that is associated with high risk of morbidity and mortality. 1,2 The incidence of PVE varies between 1% to 6% of patients with valve prostheses. The principles of surgical management for PVE are complete removal of all infected prosthetic materials and tissues followed by reconstruction of cardiac struc- tures and valve replacement or repair. 3 Infection extending to the aortic root involving an abscess is a complex variant often associated with extensive root destruction, prosthesis dehiscence and fistula forma- tion. We have previously shown that surgery for PVE is an independent risk factor for recurrent infection. 4 There is a theoretical advantage of the use of a homo- graft in resisting reinfection, through a lack of artificial materials. 3 However, there remains equipoise with respect to the optimal prosthesis for aortic root replace- ment: stented bioprosthetic or mechanical composite Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis Apostolos Roubelakis, 1 Dimos Karangelis, 2 Syed Sadeque, 1 Bobby Yanagawa, 2 Amit Modi, 1 Clifford W Barlow, 1 Steven A Livesey 1 and Sunil K Ohri 1 Abstract Introduction: The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement. Methods: Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days). Results: There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre- discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis. Conclusions: Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort. Keywords xenograft; bioconduit; prosthetic valve endocarditis; aortic root replacement; cardiac surgery 1 Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK 2 Division of Cardiac Surgery, St Michael’s Hospital, University of Toronto, Toronto, Canada Corresponding author: Dimos Karangelis, Department of Cardiac Surgery, St Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada. Email: dimoskaragel@yahoo.gr 690250PRF 0 0 10.1177/0267659117690250PerfusionRoubelakis et al. research-article 2017 Original Paper