{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T15:38:40Z","timestamp":1767713920719,"version":"3.48.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T00:00:00Z","timestamp":1765929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Infective endocarditis (IE) is associated with high morbidity and mortality; nearly 40% present with isolated aortic valve (AV) endocarditis. No detailed guidelines on surgical strategies are currently available particularly for younger patients. The aim of this study was to compare mid-term results of conventional valve (aortic valve replacement [AVR]) and root replacement and the Ross procedure in patients &amp;lt;60 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between 1997 and 2023, 176 patients &amp;gt;18 and &amp;lt;60 years underwent surgery for AV IE. Patients with AV repair (n\u2009=\u200944) were excluded; the remaining 132 (male 82%; mean age 46\u2009\u00b1\u200911 years) underwent a Ross procedure (n\u2009=\u200932), mechanical AVR (n\u2009=\u200928), biological AVR (n\u2009=\u200972). Median and mean follow-up were 6.4 (IQR 2.1-12.9) years and 7.9\u2009\u00b1\u20096.6 years (1041 patient-years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-seven patients (20%; Ross n\u2009=\u20091, biological AVR n\u2009=\u200920, mechanical AVR n\u2009=\u20096; P\u2009=\u2009.033) required permanent pacemaker implantation, 15 patients had recurrent endocarditis (11%; Ross n\u2009=\u20091, biological AVR n\u2009=\u200911, mechanical AVR n\u2009=\u20093; P\u2009=\u2009.028). Survival was 78% at 15 years (Ross 92%; biological AVR 72%; mechanical AVR 70%; P\u2009=\u2009.176). At 15 years, it was 79% after native valve and 73% after prosthetic valve IE (P\u2009=\u2009.622), and 66% after biological AVR and 93% after root replacement (P\u2009=\u2009.05). At 15 years, freedom from AV reoperation was 72% (Ross 73%; biological stented AVR 58%; biological stentless root replacement 76%; mechanical AVR 82%; P\u2009=\u2009.453).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term survival was good after the Ross procedure and stentless biological valves but was best after the Ross procedure with the lowest valve-related complications. Reoperation was non-negligible but similar between the Ross procedure and the stentless biological root. Abscess exclusion with a patch and subsequent valve replacement was associated with inferior results. The Ross procedure offers the best potential for true long-term durability. In patients &amp;gt;50 years, stentless biological root replacement may be an alternative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf460","type":"journal-article","created":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T12:56:41Z","timestamp":1765976201000},"source":"Crossref","is-referenced-by-count":0,"title":["Role of the Ross Procedure and Stentless Biological Prostheses in Acute Aortic Valve Endocarditis"],"prefix":"10.1093","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6110-3124","authenticated-orcid":false,"given":"Karen B","family":"Abeln","sequence":"first","affiliation":[{"name":"Department Cardiovascular Surgery, Saarland University Medical Center , 66424 Homburg\/Saar,","place":["Germany"]},{"name":"Saarland University , 66424 Homburg\/Saar,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00f6ren L","family":"Becker","sequence":"additional","affiliation":[{"name":"Saarland University , 66424 Homburg\/Saar,","place":["Germany"]},{"name":"Institute of Medical Microbiology and Hygiene, Saarland University , 66424 Homburg\/Saar,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophie E","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology and Hygiene, Saarland University , 66424 Homburg\/Saar,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Schneider","sequence":"additional","affiliation":[{"name":"Saarland University , 66424 Homburg\/Saar,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0251-9100","authenticated-orcid":false,"given":"Hans-Joachim","family":"Sch\u00e4fers","sequence":"additional","affiliation":[{"name":"Saarland University , 66424 Homburg\/Saar,","place":["Germany"]},{"name":"Prof. Emeritus, Saarland University , 66424 Homburg\/Saar,","place":["Germany"]},{"name":"Department of Thoracic and Cardiovascular Surgery, Westpfalz Hospital , 67655 Kaiserslautern,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,12,17]]},"reference":[{"key":"2026010610220736100_ezaf460-B1","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1016\/j.athoracsur.2006.02.023","article-title":"Surgical management of infective endocarditis: early predictors of short-term morbidity and mortality","volume":"82","author":"Jassal","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"2026010610220736100_ezaf460-B2","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.athoracsur.2013.03.060","article-title":"Surgical treatment of aortic valve endocarditis with left ventricular-aortic discontinuity","volume":"96","author":"Takahashi","year":"2013","journal-title":"Ann Thorac 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