International Society For Minimally Invasive Cardiothoracic Surgery

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Explantation Of Infected Rapid Deployment Aortic Valves: Feasibility And Outcome
Romina Roesch, Martin Oberhoffer, Sophie Forster, Maximilian Dittes, Lena Brendel, Katja Buschmann, Christian Vahl.
Department of Cardiothoracic and Vascular Surgery ; University Hospital Mainz, Mainz, Germany.

Introduction:
Infective Endocarditis (IE) following rapid-deployment surgical aortic valve procedure (RDAVR) is a rare complication. In the literature only one case describing the technique of explanting a sutureless aortic valve (PercevalTM, LivaNova) exists. We found no report describing surgical method or complexity of removing an Edwards IntuityTM valve. Surgeons would expect that removing the valve with its balloon-expandable stainless steel frame is complex and problematic regarding damage to the aortic ring and the left ventricular outflow tract (LVOT). We report a series of six patients with IE after previous RDAVR (Edwards IntuityTM) treated surgically.
Methods:
Between 09/2016 and 08/2018 six patients were operated for IE after Edward IntuityTM valve replacement. Patients were identified from our institutional database and analyzed retrospectively regarding demographics, postoperative course, and outcome. We focused on the feasibility and operative technique.
Results:
Mean age of the six patients was 70 7 years (male: n=4). IE was diagnosed 40 39 month after RDAVR, 2/6 patients had an early onset of PVE. Indication for reoperation were floating structures in 5/6 patients, sepsis with hypotension in 2/6, and severe aortic regurgitation in 1/6 patients. The open explantation of the Intuity valves was uncomplicated in 5/6 cases if sufficient exposure was given by a low aortotomy down to the aortic ring. After removing the valve-specific guiding sutures, in all cases the valve could easily be pulled out after careful dissection and exposure of the sewing ring. In no case the LVOT had to be reconstructed. 5 patients received a Medtronic HancockTM, one patient a mechanical valve (St. Jude Medical RegentTM). Mean cardiopulmonary bypass time and cross-clamp time were, 139 53 minutes and 88 19 minutes, respectively. Concomitant cardiac procedure was CABG in 1/6. Median time on mechanical ventilation was 41 15 hours. In hospital mortality was 33 % (two patients died due to septic multiorgan failure).
Conclusion:
In our series of six patients undergoing reoperation for PVE of a RDAVR we demonstrated that surgical explantation of an Edwards IntuityTM valve was feasible save and easily performed without damage to the LVOT.


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