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Original Articles: Cardiovascular

Aortic Root Replacement for Destructive Aortic Valve Endocarditis with Left Ventricular–Aortic Discontinuity

Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

Accepted for publication October 26, 2007.

^_* Address correspondence to Dr Okada, Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan (Email: yutamo{at}aol.com).

Background: Destructive aortic valve endocarditis causes the development of left ventricular–aortic discontinuity. Our experience of aortic root replacement in patients with the left ventricular–aortic discontinuity is presented.

Methods: Between 1999 and 2006, 8 patients (7 men, 1 woman) with left ventricular–aortic discontinuity underwent aortic root replacement in our institute. Their mean age was 56 years. Six patients were in New York Heart Association functional class III or higher. Four patients were diagnosed to have native valve endocarditis, and 4 had prosthetic valve endocarditis (previous aortic valve replacements in 2 patients, aortic root replacements in 2). Radical débridement of the aortic root abscess was performed in all patients, followed by reconstruction of the aortic annulus using autologous or xenogenic pericardium in 2 patients. Fibrin glue saturated with antibiotics was applied into the cavity in 5 patients. Aortic root replacement was achieved with pulmonary autograft (Ross procedure) in 4 patients and stentless aortic root xenograft in 3. One patient who had advanced liver cirrhosis underwent aortic valve replacement with a stentless xenograft by subcoronary fashion.

Results: No patients died during hospitalization or follow-up. Freedom from major adverse cardiac events was noted in 67% of the patients at 5 years.

Conclusions: An excellent outcome can be achieved by radical exclusion of abscess in the cavity, followed by root replacement with viable pulmonary autograft or flexible stentless aortic root xenograft in patients with left ventricular–aortic discontinuity.