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Root-commando operation with a modified self-assembled aortic root conduit for endocarditis after sutureless aortic

Anton Pechenenko1, Maksym Rzhanyi2, Robert Pruna-Guillen3

  • 1Cherkasy Regional Cardiology Center, Cherkasy, Ukraine. This is a municipal non-profit enterprise.

Multimedia Manual of Cardiothoracic Surgery : MMCTS
|November 6, 2023
PubMed
Summary

Staphylococcus epidermidis caused early prosthetic valve endocarditis after sutureless aortic valve replacement. A novel root-commando technique using a self-assembled conduit offered an alternative surgical solution.

Keywords:
Annular enlargementAortic root replacementCommando operationInfective endocarditisRoot abscessSelf-assembled aortic root conduitSutureless aortic valve prosthesis

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Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Prosthetic Valve Complications

Background:

  • Early prosthetic valve endocarditis (PVE) is a rare but serious complication following aortic valve replacement.
  • Sutureless aortic valve replacement (SAVR) offers minimally invasive benefits but requires careful management of potential complications.
  • Staphylococcus epidermidis is a common pathogen implicated in PVE, often associated with biofilm formation and abscess development.

Observation:

  • A patient developed Staphylococcus epidermidis PVE with a root abscess, fistula, severe mitral regurgitation, and patent foramen ovale post-SAVR.
  • The infection led to significant structural damage, including a large mitral vegetation and periprosthetic leaks.
  • The complex presentation necessitated a multi-stage surgical intervention.

Findings:

  • Surgical management involved redo sternotomy, explantation of the sutureless prosthesis, and debridement of the abscess.
  • A novel root-commando procedure was performed using a self-assembled mechanical aortic root conduit for aortic and mitral valve replacement.
  • This technique serves as a viable alternative to standard allograft or bioprosthetic root reconstructions.

Implications:

  • The case highlights a successful management strategy for complex PVE after SAVR.
  • The described self-assembled conduit technique offers a flexible and potentially cost-effective option for aortic root reconstruction.
  • This approach may be adaptable for use with various prosthetic valve types, including stented bioprostheses.