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Feasibility Of Minimally Invasive Approach For Surgical Correction Of Aortic Root Abscess
Igor Mokryk,
Ihor Stetsyuk, Illia Nechay, Borys Todurov;
Heart Institute, Kyiv, Ukraine
BACKGROUND: Infective endocarditis (IE) of the aortic valve (AV) is complicated by aortic root abscess (ARA) in 10-37% of cases. In-hospital mortality in operated patients is high, reaching 15%.Compared to median sternotomy, a minimally invasive approach leads to shorter ventilation time, faster recovery, and fewer postoperative wound complications. Literature reports on minimally invasive correction of ARA are few. Herein, we analyze our experience in the surgical management of patients with ARA operated on through J-sternotomy.
METHODS: We retrospectively analyzed the medical notes of three consecutive patients operated at our Institution for ARA through J-sternotomy from December 2020 to February 2022. Patient age was 50.5 ± 21.92 y. There was one male (33,3%). All patients preoperatively received a course of antibiotic therapy and were operated on emergent basis.
RESULTS: In all patients, the preoperative EchoCG revealed bicuspid AV with mobile vegetations and severe aortic insufficiency. EDV was - 161.6 ± 30.3 ml, LVEF - 49.2 ± 7.12 %. All operations were performed through upper J-sternotomy. There were no conversions to MS. In one case, there was required an extensive patch reconstruction of the AR. In two other patients, an abscess cavity was obliterated with the pledget sutures technique. Mechanical aortic valves were used in all patients. The postoperative period was uneventful: ventilation time was 4, 8, and 5 hours; ICU stay was 2.3 ± 0.5 days; postoperative hospital stay was 10.33 ±1.92 days. EchoCG at discharge demonstrated a mean peak pressure gradient 21.3 ± 5.1 mmHg. EDV - 141.66 ±10.4 ml, LVEF - 58 ± 2%.The mean postoperative follow-up was 13 months. EchoCG at follow-up demonstrated no paravalvular leaks and mean peak pressure gradient 22.0 ± 4.3 mm Hg.
CONCLUSIONS: Our case series demonstrated feasibility of upper J-sternotomy for surgical correction of complex ARA. A larger multicentre comparative to standard approach study is required to confirm the conclusions of our experience.
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