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J Thorac Cardiovasc Surg 2006;131:243-245
© 2006 The American Association for Thoracic Surgery

Brief Communication

Monobloc aorto-mitral homograft or mechanical valve replacement: A new surgical option for extensive bivalvular endocarditis

^a INSERM, Service de Chirurgie Cardiothoracique et Transplantation (Cardiothoracic Surgery and Transplant Department), Hôpital Cardiothoracique Louis Pradel
^b Service de Cardiologie (Cardiology Department), Hôpital Cardiothoracique Louis Pradel, Lyon-Bron
^c Centre Cardiologique du Nord, Saint Denis Cedix, France

Received for publication May 18, 2005; accepted for publication May 26, 2005.

^_* Address for reprints: Professeur J. F. Obadia, Hôpital Cardiothoracique Louis Pradel 28, avenue du Doyen Lépine—69677, Bron, France (Email: jf.o@chu-lyon.fr).

The first 20% of the full text of this article appears below.

Aortic and mitral prosthetic valve endocarditis with extensive abscess is generally considered to be a critical situation with no satisfactory technical solution. ^1,2 Although we respect the principle of wide resection proposed by Tirone David, ³ we report a simplified reconstruction solution using an aorto-mitral monobloc.

Technique

The first step consists of wide resection including the aortic and mitral valve prostheses, the proximal aorta, and the aorto-mitral curtain. This resection leaves a single gaping aorto-mitral orifice and 2 button-shaped coronary ostia. The second step of reconstruction can be simplified, when it is planned, using either a monobloc aorto-mitral homograft (Figure 1), for which we have already described the implantation technique, ⁴ or a monobloc mechanical prosthesis prepared before starting cardiopulmonary bypass to limit the duration of the crossclamp time (Figure 2).

View larger version (134K): [in this window] [in a new window]   Figure 1. Monobloc aorto-mitral homograft. All hearts harvested for our tissue bank are dissected so the homograft includes the aortic valve and mitral valve in a single monobloc. When the surgeon thaws the monobloc, he or she can continue dissection to obtain an aortic valve, a mitral valve, or a bivalvular monobloc as necessary.

View larger version (141K): [in this window] [in a new window]   Figure 2. Monobloc aorto-mitral . . . [Full Text of this Article]

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