Surgical treatment of infective endocarditis with aortic and tricuspid valve involvement using cryopreserved aortic and mitral valve allografts

Abstract

Surgical treatment of infective and prosthetic endocarditis using allografts gives good results. Aortic allograft implantation is a common technique, while tricuspid valve replacement with a mitral allograft is very rare. Multiple valve disease in case of infective endocarditis is a surgical challenge as such patients are usually in a grave condition and results of surgical treatment are often unsatisfactory. In this article we describe a clinical case of successful surgical treatment in a patient with active infective endocarditis of aortic and tricuspid valve, complicated by an aortic-right ventricular fistula. The aortic valve and ascending aorta were replaced with a cryopreserved aortic allograft; the tricuspid valve was replaced with a cryopreserved mitral allograft.

Use of the Perceval Sutureless Valve in Active Prosthetic Aortic Valve Endocarditis

“…Annular reconstruction with a patch may not always be easy to perform in the context of friable tissue. Some groups have reported the use of homografts [10] or allografts [12] for treating PAVE. Perrotta and associates [10] reported a trend of higher early, 5-year, and 10-year mortality with homografts (10.7%, 75%, and 58%, respectively) compared with prosthetic valve implantation, although the difference was not statistically significant.…”

Original technique for tricuspid valve replacement by mitral homograft: Step‐by‐step approach and initial results

“…Another challenging issue is the proper orientation of homograft to the annulus and insertion of papillaries into RV that could be achieved by implantation to ventricle septum, native papillary muscles, or RV free wall. 19,21 To date, not only has proper annulus orientation not been defined but also the place of papillary fixation into RV. We propose orthotopic orientation of homograft in the tricuspid position with the anterior leaflet of the homograft to be adjusted to the anterior portion of the tricuspid annulus and posterior homograft leaflet to the septal portion, respectively, and papillary muscles suturing to the intraventricular septum (inflow part) to the point according to on-table measurements.…”

“…In our case series, we tried to make the procedure easier by preimplantation of papillary muscles into the RV cavity, leaving sutures untied. Another challenging issue is the proper orientation of homograft to the annulus and insertion of papillaries into RV that could be achieved by implantation to ventricle septum, native papillary muscles, or RV free wall 19,21 . To date, not only has proper annulus orientation not been defined but also the place of papillary fixation into RV.…”

An alternative approach for complicated prosthetic aortic valve endocarditis

“…These options, however, carry increased surgical risk. Use of homografts [ 2 ], or even allografts [ 3 ], has also been reported for similar pathology. Furthermore, an alternative approach would be the implantation of stentless bioprosthesis which minimize the burden of foreign material [ 4 ].…”

“…2 Department of Echocardiography Mitera Hospital, 15123 Athens, Greece. 3 Department of Cardiac Surgery, Mitera Hospital, 15123 Athens, Greece.…”