Reversed Root for Entirely Biological Aortic Valve and Ascending Aorta Replacement in a Patient with Endocarditis and Mediastinitis

Abstract

A 59-year-old patient developed endocarditis with coagulase-negative staphylococci after aortic composite graft replacement and pacemaker implantation. She underwent complete pacemaker removal and tricuspid valve reconstruction. Pus was present in and around the aortic graft. Re-replacement of the aortic root and ascending aorta using only biological material was performed. A 23-mm full root stentless prosthesis (Vascutek Root Elan, Vascutec, Terumo, Leeds, UK) was used for aortic root replacement, and a second 25-mm full root prosthesis with removed cusps implanted in a reversed fashion was used for ascending aorta and proximal aortic arch replacement.

Key words

Heart valve surgery - aortic disease - cardiovascular surgery

References

• 1 Sohail M R, Uslan D Z, Khan A H et al. Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection.  Mayo Clin Proc. 2008;  83 (1) 46-53
• 2 Nguyen D T, Delahaye F, Obadia J F for the AEPEI study group et al. Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses.  Eur J Cardiothorac Surg. 2009;  37 1025-1032
• 3 Kato M, Imanaka K, Kyo S, Ohuchi H, Asano H, Takamoto S. Successful treatment of ascending aortic graft infection after operation for acute aortic dissection with peripheral malperfusion.  Ann Thorac Surg. 2004;  77 (6) 2194-2195
• 4 Anguera I, Miro J M, Cabell C H ICE-MD investigators et al. Clinical characteristics and outcome of aortic endocarditis with periannular abscess in the International Collaboration on Endocarditis Merged Database.  Am J Cardiol. 2005;  96 (7) 976-981
• 5 Raanani E, David T E, Dellgren G, Armstrong S, Ivanov J, Feindel C M. Redo aortic root replacement: experience with 31 patients.  Ann Thorac Surg. 2001;  71 (5) 1460-1463
• 6 Sato S, Saiki Y, Nitta Y, Oda K, Takahashi G, Tabayashi K. Redo total aortic arch replacement using an extended homograft for graft infection.  Jpn J Thorac Cardiovasc Surg. 2006;  54 (10) 448-450