A Case of Aortic Valve Replacement after 20 Years of Aortic Root Replacement by Cryopreserved Homograft

Hidehito KUROKI; Hironobu SAKURAI; Kenji YOKOYAMA; Satoshi YAMAMOTO; Takeshi SOMEYA

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A Case of Aortic Valve Replacement after 20 Years of Aortic Root Replacement by Cryopreserved Homograft

VernacularTitle:凍結保存ホモグラフトによる大動脈基部置換20年後に大動脈弁置換術を施行し得た1例
Author: Hidehito KUROKI ¹ ; Hironobu SAKURAI ² ; Kenji YOKOYAMA ¹ ; Satoshi YAMAMOTO ¹ ; Takeshi SOMEYA ¹
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1. Department of Cardiovascular Surgery, Ome Medical Center
2. Department of Cardiovascular Surgery, Japanese Red Cross Musashino Hospital
Keywords: homograft; prosthetic valve infective endocarditis; bovine pericardial patch
From:Japanese Journal of Cardiovascular Surgery 2024;53(4):193-197
CountryJapan
Language:Japanese
Abstract: A 78-year-old man presented with back pain 20 years after aortic root replacement using a homograft and was admitted with a diagnosis of pyogenic spondylitis. The patient had a history of prosthetic valve infective endocarditis (PVE) 9 months after aortic valve replacement (AVR) at 57 years of age at another hospital, and had undergone aortic root replacement using a homograft. Streptococcus anginosus was detected in blood culture, and antibiotic therapy was commenced according to the treatment of PVE. During the course of the treatment, the diagnosis of PVE was confirmed due to worsening aortic regurgitation (AR) and a finding of suspected vegetation attachment to the right coronary cusp. Since there were no embolic symptoms or heart failure, antibiotic therapy was preceded by surgery on the 33rd day. Intraoperatively, the homograft showed a highly calcified sinus of Valsalva and each valve leaflet was very fragile. The aortic valve had a vegetation adherent to the tip of the right coronary leaflet, but the infection was localized and did not extend to the annulus. Although aortic root replacement had been considered, the patient was elderly and had impaired activities of daily living, so AVR was performed in order to reduce the invasiveness of the procedure. The annulus was so hard that the needle could not be passed through. It was possible to thread the annulus by inserting the needle through the autologous tissue below the suture line on the proximal side of the homograft at the previous surgery. A bovine pericardial patch was used to close the aortotomy line of sclerotic homograft. There was no recurrence of infection, and the patient was transferred to the hospital for rehabilitation on postoperative day 37. The optimal surgical technique should be considered according to the degree of calcification and the patient's background in each case, as grafts are often highly calcified in cases of reoperation after homograft replacement.