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Eur J Cardiothorac Surg 2005;28:509-510
© 2005 Elsevier Science NL

Letter to the Editor

Translocation of the aortic valve in severe aortic root abscess. An alternative to homografts

Nawwar Al-Attar * , Rémi Nottin, Ramzi Ramadan, Alexandre Azmoun

Centre Chirurgical Marie Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis Robinson, France

Received 15 May 2005; accepted 10 June 2005.

* Corresponding author. Tel: +33 1 40 94 29 64; fax: +33 1 40 94 67 12. (Email: nalattar{at}gmail.com).

Key Words: Endocarditis • Aortic valve • Surgery

We read with interest the paper of Siniawski et al. on the treatment of aortic root abscess and secondary infective mitral valve disease [1]. We would like to congratulate them on their excellent results and a very interesting paper.

In the treatment of severe aortic endocarditis and even more with aortic root damage following prosthetic aortic valve endocarditis (PVE), we believe that there is an alternative to homografts.

Although aortic homografts have generally been considered as first choice substitute material in such patients given their supposedly greater resistance to infections compared to prosthetic valves, however, persistent infections have been reported after homograft replacement [2]. Furthermore, homografts may not be adapted to reconstruct a severely damaged aortic root. Moreover, they are fraught with high early calcification rates and the problems of availability. The favourable results of endocarditis treated with prosthetic material [2,3] question the absolute necessity of employing biological grafts in the treatment of infectious endocarditis and advocate the use of prosthetic material with comparable results [4].

We recently published a 22 year experience of translocation of the aortic valve permitting surgical repair of ventriculo-aortic disconnection and aortic root damage following PVE in 21 patients [5].

We believe that the key to success lies in appropriate debridement of all infected tissue that we liken to the principles of ‘cancer surgery’ where the maximum of necrotic and infected tissues is resected. The use of prosthetic material can be employed on the condition that it be distanced from the focus of the infection, thus ‘translocation’ of the valve prosthesis in an aortic tube. The latter is necessary to reconstruct the left ventricular outflow tract and provides secure positioning of the valve prosthesis.

We emphasize that this technique is reserved for patients with extensive annular destruction and sub-annular abscesses after failure of conventional methods and can be used as an alternative to homografts whenever these are unavailable.

References

  1. Siniawski H, Grauhan O, Hofmann M, Pasic M, Weng Y, Yankah C, Lehmkuhl H, Hetzer R. Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment. Eur J Cardiothorac Surg 2005;27:434-440.[Abstract/Free Full Text]
  2. Bauernschmitt R, Jakob HG, Vahl CF, Lange R, Hagl S. Operation for infective endocarditis: results after implantation of mechanical valves. Ann Thorac Surg 1998;65:359-364.[Abstract/Free Full Text]
  3. Aagaard J, Andersen PV. Acute endocarditis treated with radical debridement and implantation of mechanical or stented bioprosthetic devices. Ann Thorac Surg 2001;71:100-104.[Abstract/Free Full Text]
  4. Hagl C, Galla JD, Lansman SL, Fink D, Bodian CA, Spielvogel D, Griepp RB. Replacing the ascending aorta and aortic valve for acute prosthetic valve endocarditis: is using prosthetic material contraindicated?. Ann Thorac Surg 2002;74:S1781-S1785.[Abstract/Free Full Text]
  5. Nottin R, Al-Attar N, Ramadan R, Azmoun A, Therasse A, Kortas C, Ly M, Bouchachi A, Bourachot-Montanteme ML. Aortic valve translocation for severe prosthetic valve endocarditis: early results and long-term follow-up. Ann Thorac Surg 2005;79:1486-1490.[Abstract/Free Full Text]




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