Sutureless Aortic Valve in a High-Risk Patient Suffering from Staph. aureus Active Infective Endocarditis after Bio-Bentall Surgery
Ahmed Mashhour, MB BCh, Alexander Weymann, PD Dr. med., Albrecht Elsässer, Prof. Dr. med., Pascal M. Dohmen, Prof. Dr. med..
University Hospital Oldenburg, Oldenburg, Germany.
A multi-morbid 70-year-old male patient with sepsis due to active infective prosthetic aortic valve endocarditis (PVE) with positive blood cultures (Staphylococcus aureus). This PVE was accompanied by septic encephalopathy with delirium and suspected splenic abscess. Secondary findings were moderate mitral and severe tricuspid regurgitation and intermittent atrial fibrillation, as well as three-vessel coronary disease.
Relevant medical history was a previous cardiac surgery six months ago (combined CABG with Bio-Bentall procedure using a 29-mm Shelhigh conduit). This previous procedure was unremarkable and the patient was discharged 8 days after surgery.
The patient suffered from severely reduced general condition, however due to a Staph. aureus PVE in this high-risk patient with previous Bio-Bentall, we wanted to avoid replacement of the ascending aorta or the aortic root, so that a sutureless valve would be a viable option. The clamp time spared during implantation of the aortic valve would also compensate for the time needed for mitral and tricuspid reconstruction.
Discussion/Course of the Case
Overall, the operation went as planned. The aortic arch was used for arterial cannulation. Blood cardioplegia directly through the coronary ostia and systemic cooling to 31° C were utilized. The heart was vented over the left atrium. Aortic leaflets together with the annulus and the large vegetations were excised. After that, the mitral valve was reconstructed trans-septally with a 26-mm CG Future ring, followed by modified DeVega for the tricuspid valve. Finally, a 25-mm sutureless Perceval valve was implanted with annulus reconstruction using a pericardial patch. The antibiotic therapy was continued postoperatively according to resistance. A pacemaker was implanted one week after surgery due to persistent bradycardia. The postoperative course was complicated by transient postoperative delirium, as well as acute renal failure, which responded to medical therapy. The patient was discharged on the 33rd postoperative day.
Looking at this case, we demonstrate the feasibility of using a sutureless Perceval bioprosthesis inside an aortic graft and stress the advantage of such valve in re-do surgery in saving operative time in combined heart valve surgery.
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