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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
14:14

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

[Surgery for aortic valve endocarditis]

Kenji Okada1, Yutaka Okita

  • 1Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.

Nihon Geka Gakkai Zasshi
|February 21, 2009
PubMed

Insights

Early diagnosis of infective endocarditis is vital. A new cardiopulmonary bypass strategy using nafamostat mesilate shows promise in preventing brain hemorrhage complications during surgery for aortic valve endocarditis.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Context:

  • Infective endocarditis (IE) is a severe infection requiring prompt diagnosis via Duke's criteria, blood cultures, and echocardiography.
  • IE often leads to intracardiac and extracardiac complications, frequently necessitating surgical intervention.
  • Managing IE with concurrent brain complications presents challenges, particularly regarding anticoagulation during cardiopulmonary bypass (CPB).

Purpose:

  • To evaluate a novel CPB strategy using nafamostat mesilate as an anticoagulant for patients with recent intracranial hemorrhage undergoing surgery for IE.
  • To assess the safety and efficacy of aortic root replacement in patients with destructive aortic valve endocarditis causing left ventricular-aortic discontinuity.

Summary:

  • A novel CPB strategy with nafamostat mesilate demonstrated potential safety in preventing the deterioration of recent intracranial hemorrhage.
  • Nine patients with left ventricular-aortic discontinuity due to destructive aortic valve endocarditis underwent aortic root replacement using pulmonary autografts or xenografts.
  • Radical debridement of aortic root abscesses was performed in all cases.

Impact:

  • The novel CPB strategy may offer a safer anticoagulation option for IE patients with intracranial hemorrhage.
  • Aortic root replacement procedures for severe aortic valve endocarditis resulted in no in-hospital mortality.
  • Patients undergoing aortic root replacement achieved 67% freedom from major adverse cardiac events at 5 years, indicating favorable long-term outcomes.

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