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J Thorac Cardiovasc Surg 2003;125:200-203
© 2003 The American Association for Thoracic Surgery

Brief Communications

Aortic root replacement with Freestyle stentless valve for complex aortic root infection

Toshihiro Fukui, MD, Shigefumi Suehiro, MD, Toshihiko Shibata, MD, Koji Hattori, MD, Hidekazu Hirai, MD, Takanobu Aoyama, MD Osaka, Japan

From the Department of Cardiovascular Surgery, Osaka City University Medical School, Osaka, Japan.

Received for publication Jan 23, 2002 Accepted for publication April 15, 2002. Address for reprints: Toshihiro Fukui, MD, Department of Cardiovascular Surgery, Osaka City University Medical School, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan (E-mail: tm-fukui@gem.hi-ho.ne.jp).

The first 300 words of the full text of this article appear below.

Aortic valve replacement in the presence of infectious endocarditis with an aortic annular abscess, aortic root destruction, and left ventricular-aortic discontinuity, remains a formidable surgical challenge. Early diagnosis and surgical intervention can be lifesaving.Go Go 1-3 Radical débridement of infected tissues and reconstruction of the left ventricular outflow tract are fundamental tenets of treatment. However, the choice of valve substitute remains one of the most contentious subjects in the management of this condition. Although several researchersGo Go 3-6 have reported success with homografts and autografts, prosthetic valve replacement remains the standard surgical approach.Go Go 7-9

Recently the porcine stentless bioprosthesis has gained favor as an aortic valve replacement because its hemodynamic performance is excellent and it has good midterm durability.Go Go 10-12 We have used this prosthesis in 5 patients with complex aortic root infection during the past 3 years, and that experience is the basis of this report.

Patients and methods (Table 1)


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  		Table 1. Demographic and preoperative clinical characteristics of patients with complex aortic root infection
 
We treated 5 patients, 2 men and 3 women (aged 42 to 73 years), who underwent stentless valve replacement for infectious endocarditis involving the native valve (n = 1) or a prosthetic valve (n = 4) between October 1998 and September 2001. Two patients with prosthetic valve endocarditis had been operated on twice previously. Recurrent prosthetic valve endocarditis (case 1) or perivalvular leakage (case 4) was the indication for the second operation. In case 4, saphenous vein grafting to the right coronary artery was also performed. In case 2, the Bentall operation and triple coronary artery bypass grafting had been conducted previously. Three mechanical valves and one stented bioprosthesis had been used, and the mean interval between the previous and current operation was 28.5 months (range 2-61 months) in the patients with prosthetic valve endocarditis.

One patient underwent surgery after inflammation had subsided in response . . . [Full Text of this Article]




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