Extraanatomical bypass of the aortic root: an experimental technique

Endocarditis involving a prosthetic aortic valve is associated with persistently positive blood cultures and aortic regurgitation. With rare exception, it is a fatal disease. An experimental technique was developed that would allow for removal of the infected aortic prosthesis with debridement and permanent closure of the aortic root. An extraanatomical outflow for the left ventricle was created using a valve-containing conduit between the apex of the left ventricle and the descending thoracic aorta (apicoaortic anastomosis). The procedure was performed on 5 mongrel dogs through a left thoracotomy without use of cardiopulmonary bypass. Four survived the procedure and required no cardiotonic support. One died as a result of a technical problem. Intraoperative pressure determination revealed a 0 to 15 mm Hg gradient across the apioaortic prosthesis and a left ventricular end-diastolic pressure of 0 to 4 mm Hg. Both postoperative angiocardiogram and postmortem examination confirmed patency of the aortocoronary bypass grafts and good function of the prosthesis.