Apico-aortic conduit for aortic stenosis in a patient with chronic thoracic wall infection

We report a case of an apico-aortic bioprothesis-valved conduit for a 70-year-old-woman with symptomatic, severe aortic stenosis and severe calcification of the ascending aorta. She had a history of mastectomy and radiation therapy for breast cancer and was suffering from radiodermatitis and chronic thoracic wall infection. Transthoracic echocardiography showed severe aortic valve stenosis with heavy calcification and high aortic valve pressure gradients. In patients with a chronically infected thoracic wall, median sternotomy is considered to be a high risk procedure, resulting in postoperative mediastiniti; therefore, we applied a technique in which we used an apico-aortic conduit via posterolateral thoracotomy. We underwent apico-aortic bypass with a hand-made composite graft: 19-mm bioprosthetic valve and a 22-mm woven polyester vascular graft. The surgical intervention successfully decreased pressure gradient across the aortic valve, also separating an incision from chronic infection allowed us to avoid postoperative mediastinitis. The patient had remained in good condition for 15 months without developing any complications.