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Ann Thorac Surg 2005;79:1486-1490
© 2005 The Society of Thoracic Surgeons

Original articles: Cardiovascular

Aortic Valve Translocation for Severe Prosthetic Valve Endocarditis: Early Results and Long-Term Follow-Up

Rémi Nottin, MD*, Nawwar Al-Attar, FRCS, Ramzi Ramadan, MD, Alexandre Azmoun, MD, Alexis Therasse, MD, Chokri Kortas, MD, Mohamedou Ly, MD, Amir Bouchachi, MD, Marie-Laure Bourachot-Montantême, MD

Department of Adult Cardiovascular Surgery, Marie-Lannelongue Hospital, Le Plessis-Robinson, France

Accepted for publication October 14, 2004.

* Address reprint requests to Dr Nottin, Marie-Lannelongue Hospital, 133 Ave de la Résistance, 92350 Le Plessis-Robinson, France (E-mail: rnottin{at}ccml.com).

BACKGROUND: Surgical management of ventriculo-aortic disconnection and aortic root abscesses after prosthetic aortic valve endocarditis carries high mortality and morbidity. Initial experience with translocation of the aortic valve and distal coronary artery bypass grafting was disappointing in terms of short-term and long-term success in the few published reports. We describe a technique of translocation of the aortic valve into the ascending aorta with direct antegrade myocardial revascularization.

METHODS: Between 1980 and 1992, we included 21 patients and evaluated their long-term outcome. The surgical technique included extracting the aortic valve prosthesis, resecting all infected tissue, restoring the left ventricular outflow tract, and translocating the aortic valve into the ascending aorta, associated with myocardial revascularization of the left main trunk and the proximal right coronary artery.

RESULTS: All patients required emergency surgery: 15 patients were in severe congestive heart failure, 3 patients were in cardiogenic shock, and 3 patients had multiple neurologic and peripheral signs of distal embolization. Fifteen patients had active prosthetic valve endocarditis. Intraoperative findings dictated the translocation. The overall hospital mortality was 14%. None of the 18 hospital survivors had prosthetic aortic valve endocarditis recurrence. All patients were observed from 12 to 22 years, are alive, and have resumed normal activities.

CONCLUSIONS: In severe forms of prosthetic valve endocarditis, this technique provides a safe and reliable alternative to homograft replacement. The long-term results are satisfactory.




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 Eur. J. Cardiothorac. Surg.Home page
N. Al-Attar, R. Nottin, R. Ramadan, and A. Azmoun
Translocation of the aortic valve in severe aortic root abscess. An alternative to homografts
Eur. J. Cardiothorac. Surg., September 1, 2005; 28(3): 509 - 510.
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