Surgical treatment of prosthetic valve endocarditis with left ventricular-aortic discontinuity: Reconstruction of the left ventricular outflow tract with a xenopericardial conduit
S. Aoyagi et al., Surgical treatment of prosthetic valve endocarditis with left ventricular-aortic discontinuity: Reconstruction of the left ventricular outflow tract with a xenopericardial conduit, J HEART V D, 10(3), 2001, pp. 367-370
Background and aim of the study: Aortic prosthetic valve endocarditis (PVE)
with annular destruction presents a challenge that requires techniques to
eradicate the infection and correct the hemodynamic abnormality.
Methods: Between July 1, 1996 and March 31, 2000, six patients with native
or PVE of the aortic valve and aortic annular destruction underwent surgica
l treatment. Of these patients, three (two men, one woman; mean age 71.0 ye
ars) had circumferential annular destruction of the aortic annulus, and for
med the basis of this study. The microorganisms responsible for the infecti
on were Streptococcus spp. in two patients and Staphylococcus aureus in one
patient. In addition to aggressive debridement of the infected tissue, rep
air was achieved by reconstruction of the left ventricular outflow tract wi
th a xenopericardial conduit and fixation of the new prosthetic valve to th
e conduit.
Results: One patient with ventricular septal perforation, multiple systemic
embolism and sepsis died of low cardiac output syndrome soon after surgery
Two operative survivors were followed up for 9 and 51 months, with no late
deaths. No patient has experienced recurrent infection, pericardial patch
aneurysm, or prosthetic valve detachment.
Conclusion. These operative procedures provide easy and secure fixation of
the pericardial patch to the healthy tissue under excellent operative view,
as well as a sturdy structure for the fixation of the new prosthesis, and
complete exclusion of the abscess cavity from the blood stream.