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J Thorac Cardiovasc Surg 2010;139:1077-1081
© 2010 The American Association for Thoracic Surgery

Brief Technique Report

The incorporated aortomitral homograft: A new surgical option for double valve endocarditis

Cleveland Clinic, Cleveland, Ohio

Received for publication May 1, 2009; accepted for publication May 17, 2009.

^_* Address for reprints: Jose L. Navia MD, FACC, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.

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

	Introduction

 
The repair or reconstruction of a disrupted aortomitral curtain or intervalvular fibrous body (IFB), as a result of extensive endocarditis with abscess formation or of reoperation, is a challenge to the cardiac surgeon.¹ In this report, we describe a new surgical technique for repair or reconstruction of the IFB in the setting of double valve endocarditis involving the aortic valve (AV), the mitral valve (MV) and IFB.

	Clinical Summary

 
A 57-year-old man was admitted electively after two episodes of MV and AV viridans streptococcal endocarditis. The patient was treated with antibiotics, and eventually grade 3 to 4 aortic regurgitation and grade 3 to 4 mitral regurgitation developed, as did paroxysmal atrial fibrillation. A combined procedure of bipolar radiofrequency ablation for atrial fibrillation as well as a new technique of aortomitral homograft as a single unit were discussed with the patient, who agreed to proceed and signed the informed consent form. This new technique was approved by the Institutional Review Board and Innovation Practice Committee of the Cleveland Clinic Foundation.

	Homograft Preparation

 
The aortomitral homograft was prepared by Cryolife Inc (Kennesaw, Ga). It was harvested as a single unit by opening the left atrium, preserving the dome at the level of the aortic root. The MV annulus, leaflets, and subvalvular apparatus were anatomically evaluated, and the valve, anterior, and posterior leaflet heights were measured. The distal ascending aorta was then transected, and the AV, coronary ostia, and the ascending aorta were anatomically evaluated and measured. Then the left ventricle was opened below the papillary muscle level, and the whole MV was excised or removed by incision of the valve circumferentially. The incision was placed near the fibrous annulus of the valve and around the posterior area of the annulus, preserving the aortomitral membrane, the ascending aorta, the dome of the left atrium at the reflection . . . [Full Text of this Article]

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