Aortic root replacement with Freestyle stentless valve for complex aortic root infection

Abstract

ortic valve replacement in the presence of infectious endocarditis with an aortic annular abscess, aortic root destruction, and left ventricular-aortic discontinuity, remains a formidable surgical challenge. Early diagnosis and surgical intervention can be lifesaving. [1][2][3] Radical de´bridement of infected tissues and reconstruction of the left ventricular outflow tract are fundamental tenets of treatment. However, the choice of valve substitute remains one of the most contentious subjects in the management of this condition. Although several researchers 3-6 have reported success with homografts and autografts, prosthetic valve replacement remains the standard surgical approach. [7][8][9] Recently the porcine stentless bioprosthesis has gained favor as an aortic valve replacement because its hemodynamic performance is excellent and it has good midterm durability. [10][11][12] We have used this prosthesis in 5 patients with complex aortic root infection during the past 3 years, and that experience is the basis of this report.

Treatment of prosthetic valve endocarditis complicated by destruction of the aortic annulus

“…21 Several authors have reported good outcomes for AVR in patients with PVE and aortic root abscess using a Freestyle stentless valve. 9,13,22 Because the handling qualities and performance of a Freestyle valve are similar to those of a homograft, they recommend the use of a Freestyle valve. 13,22 A composite graft or Freestyle stentless valve can serve as a good alternative to a homograft for aortic root replacement.…”

“…9,13,22 Because the handling qualities and performance of a Freestyle valve are similar to those of a homograft, they recommend the use of a Freestyle valve. 13,22 A composite graft or Freestyle stentless valve can serve as a good alternative to a homograft for aortic root replacement. However, because prosthetic valve infection does not usually extend to the sinus of Valsalva or the coronary ostium in most patients with PVE complicated with aortic root abscess, 2-9,12-15,16-19,21-25 we do not believe that aortic root replacement is always necessary.…”

“…Other surgical techniques that have been used in the past include valve replacement with patch closure of the abscess cavity, 16,17,21 aortic root replacement using a homograft, 3-7 autograft (Ross procedure), 8,9 compositevalve conduit, 18,19 Freestyle stentless bioprosthesis, 13,22 and translocation of the aortic valve with saphenous vein bypass grafts to the coronary arteries. 23,24 It is well known that both homografts and autografts offer excellent hemodynamic performance, and it is thought that they are resistant to infection.…”

Freestyle Stentless Bioprosthesis for Active Aortic Infectious Endocarditis with Undetermined Causative Organism

“…Sakaguchi et al 7 successfully treated methicillinresistant Staphylococcus aureus-induced prosthetic valve endocarditis using the Freestyle valve. Fukui et al 15 reported that the Freestyle was implanted in five patients with complex aortic root infection. Muller et al 16 described their experience with xenograft reconstruction of the aortic root and the left ventricular outflow tract using the Freestyle bioprosthesis in 10 consecutive patients with severe destructive endocarditis.…”

Medtronic Freestyle Aortic Root Bioprosthesis Implantation for the Infective Endocarditis on Aortic Root

“…Three of those five patients had prosthetic valve endocarditis. [7] Medtronic Freestyle aortic root bioprosthesis is a lifesaving choice in the treatment of aortic root endocarditis especially in countries like ours, where aortic homografts are not widely available. It is the valve type of choice in the surgical treatment of destructive aortic root endocarditis because of its wide availability, minimal non biologic content, anatomy like native aorta, excellent geometrical compatibility, optimum hemodynamical performance, no hemodynamic and structural deterioration in 10 year results and low rate of infectious complications.…”