Aortic homografts for native and prosthetic aortic valve and root endocarditis: results from the EUropean REgistry of Cryopreserved Aortic Homografts EURECAH.

Objective: To report the early and late results of patients treated with an aortic homograft for complex aortic native and prosthetic valve endocarditis. Methods: Clinical data of patients undergoing aortic valve/root replacement with an aortic homograft for infective endocarditis from 2000 to 2025 in 5 European cardiac centres have been collected in the EUropean REgistry of Cryopreserved Aortic Homografts (EURECAH) and retrospectively analyzed. Follow-up data have been collected until December 2025. Results: 544 patients, 78% males, median age 65 [54-73] years, have been enrolled in the EURECAH, including 188 (35%) native and 356 (65%) prosthetic valve endocarditis complicated by 369 (68%) annular abscess, 187 (34%) mitro-aortic discontinuity, 84 (15%) mitral valve and 24 (4%) right-sided endocarditis. Aortic homografts were implanted with full root (85%), free-hand subcoronary (11%) and inclusion technique (4%). Median CPB time was 192 [150 -239] min and aortic cross clamping was 147 [115-182] min. 247 (45%) patients died during the follow-up, including 85 (15%) periprocedural, 32 (6%) early and 130 (24%) late deaths. Median survival time was 10.2 [1.9-19.8] years. Overall survival rates were 87.9% at 30 days, 78.5% at 1 year, 67.1% at 5 years and 52.8% at 10 years. 77 (14%) patients underwent re-intervention for SVD (6%), IE (3%), non-SVD (1%), MV regurgitation (2%), coronary artery disease (1%), heart transplantation (1%) and aortic aneurysm (1%). Conclusions: The results of the EURECAH registry show that the use of an aortic homograft for native and prosthetic aortic valve and root endocarditis is safe and provides satisfactory early and late survival despite the complexity of the condition, with good long-term durability and low rates of recurrent endocarditis.