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The Role of Mentorship and Homograft Repair for Endocarditis with Complex Aortic Root Abscess
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  • Stephen Spindel,
  • Ana Claudia Costa,
  • Shinobu Itagaki,
  • Bobby Yanagawa,
  • Joanna Chikwe,
  • Paul Stelzer
Stephen Spindel
Ochsner Medical Center - New Orleans
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Ana Claudia Costa
Mount Sinai Medical Center
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Shinobu Itagaki
Mount Sinai Medical Center
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Bobby Yanagawa
St Michael's Hospital
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Joanna Chikwe
Cedars-Sinai Medical Center
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Paul Stelzer
Mount Sinai Medical Center
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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.