Left ventricular outflow tract reconstruction and translocation of the aortic valve for annular erosion: early and midterm outcomes.
OBJECTIVE
Aortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement without endocarditis, and its surgical management is challenging. We present the early and midterm results of a technique for left ventricular outflow tract and aortic root reconstruction with a polyester tube graft and translocation of the aortic valve and coronary arteries.


METHODS
A polyester tube graft is placed into the left ventricle and sutured to the left ventricular outflow tract below the area of erosion. The graft is then everted and sutured to a composite graft. Interposition polyester grafts from the coronary arteries are attached to the composite graft above the valve. This technique has been used in 12 cases. All but 1 patient had previously undergone aortic root or aortic valve replacement, and 4 had endocarditis of prosthetic (n = 2) or aortic allograft (n = 2) valves.


RESULTS
There were no in-hospital deaths. There was 1 early death from pulmonary embolism at 1 postoperative month and 2 late deaths at 15 and 64 postoperative months, both resulting from heart failure. The remaining 9 patients are alive at 3 to 132 postoperative months. Actuarial 5-year survival is 75%.


CONCLUSIONS
Left ventricular outflow tract reconstruction with translocation of the aortic valve and coronary arteries for annular erosion is a useful technique that safely excludes the area of annular erosion and eliminates left ventricular outflow tract obstruction. The procedure can be safely performed with satisfactory early outcomes and 5-year survival.
Division of Thoracic and Cardiovascular Surgery, Missouri Baptist Medical Center, St Louis, MO, USA.
Sotiris C
SC
Stamou
Michael C
MC
Murphy
Nicholas T
NT
Kouchoukos
D000328:Adult; D001021:Aortic Valve / Q000473:pathology* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D003331:Coronary Vessels / Q000601:surgery*; D004696:Endocarditis / Q000473:pathology; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters; D011183:Postoperative Complications; D016896:Treatment Outcome
D011091:Polyesters