Background and aim: Endocarditis after Bentall procedure is a rare but severe complication. Infection usually involves the prosthesis, the annulus, and can lead to pseudoaneurysm or mediastinitis. Surgery in these patients is a challenge but conservative therapy, sometime preferred because of prohibitive perioperative risk, is not effective. Aim of the study was to assess the outcome at short and long term of patients re-operated for Bentall procedure-related endocarditis.

Methods: From 2003 to 2018, 3398 patients were operated for endocarditis in 22 centres. Among them, 46 had a Bentall procedure-related endocarditis. Pre-operative characteristics were: mean age 57 ± 14, LVEF 56 ± 7%, EuroScore 28%, pre-operative shock 13%, active endocarditis 87%, perivalvular issues 63%, aortic regurgitation 17%, mitral involvement 24%. Most common pathogens involved were Staphylococcus Aureus (26%) and Enterococcus (22%). Implanted composite graft depended from age and centre/surgeon preference, were mechanical Bentall (33%), Bioconduit (30%) and Bentall with Biological Stented Prosthesis (24%).

Results: During a median hospital stay of 16.5 days, 16 (35%) patients experienced major complications, such as major bleeding (11%), sepsis (11%), MOF (11%) and renal failure (11%), leading 10 (22%) patients to early death. At univariate analysis, Staphylococcus Aureus infection was a risk factor for early (HR 8.1 (1.8–36)) and long-term mortality (HR 4 (1.2–13)). One, 5 and 10-year survival was respectively 78 ± 6%, 69 ± 9%, 69 ± 9%.

Conclusions: Surgery is effective to treat Bentall procedure–related endocarditis even if this complex procedure is affected by high perioperative mortality. Endocarditis relapse seems to be rare.