Aortic Root Replacement for Destructive Aortic Valve Endocarditis or Aortitis
10.4326/jjcvs.36.315
- VernacularTitle:大動脈弁輪破壊を伴った感染性心内膜炎，大動脈炎に対する大動脈基部再建術
- Author:
Kenji Okada
;
Hiroshi Tanaka
;
Naoto Morimoto
;
Hiroshi Munakata
;
Mitsuru Asano
;
Masamichi Matsumori
;
Atsushi Kitagawa
;
Yujiro Kawanishi
;
Keitaro Nakagiri
;
Yutaka Okita
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2007;36(6):315-320
- CountryJapan
- Language:Japanese
-
Abstract:
Destructive aortic valve endocarditis or poor controlled aortitis cause the development of left ventricular-aortic discontinuity. We reported our experience with aortic root replacement for cases of severe aortic annular destruction. Between 1999 and 2006, 9 patients with severe aortic annular destruction underwent aortic root replacement at our institute. There were 8 men and one women with a mean age of 55 years. Seven patients were in New York Heart Association functional class III. Four of 9 patients had native valve endocarditis, 4 had prosthetic valve endocarditis (previous aortic valve replacements in 2, aortic root replacements in 2) and one had active aortitis with a detached mechanical valve. Radical debridement of the infected cavity and necrotic tissue was performed in all cases, followed by reconstruction of the aortic annulus using autologous or xenogenic pericardium in 3 cases. Antibiotic-saturated fibrin glue was applied to the cavity. Aortic root replacement was achieved with a pulmonary autograft (Ross procedure) in 4 and stentless aortic root xenograft in 4. One patient who had advanced liver cirrhosis underwent aortic valve replacement with a stentless xenograft by subcoronary implantation method. No mortality was observed during hospitalization and follow-up. Reoperation within 5 years was not necessary in 66.7% of the patients. Excellent outcome can be achieved by radical exclusion of the abscess cavity and viable pulmonary autograft or stentless aortic root xenograft in patients with severe aortic annular destruction.
