Surgical Treatment of Active Aortic Prosthetic Destructive Endocarditis and Mediastinitis with Cryopreserved Allograft Implantation

Murat Kokoev, Leo Bockeria, Vladimir Mironenko, Sergey Rychin, Valeriy Umarov

Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 10:30, Press Hall, 2F

Abstract

OBJECTIVE: Allograft implantation in acute prosthetic endocarditis and mediastinitis is generally accepted treatment, but is limited due to allografts’ deficiency, scarcity of sizes’ variety and difficult preparation. We represent our 7 years' experience in such kind of reoperations. METHODS: From 2011 to 2017, we performed 16 reoperations on the aortic root with cryopreserved allograft implantation (15 males, mean age 51,1 years). Primary operations were: 5 – aortic valve replacement (2 with aortorrhaphy, 1 with tricuspid valve replacement, 1 with CABG), 7 – original Bentall procedure (1 with CABG, 1 with mitral valve replacement and De Vega procedure), 1 – aortic valve re-replacement with mitral valve replacement and tricuspid valve annuloplasty, 1 – replacement of aortic and mitral prostheses, 1 – prosthetic aortic valve replacement with allograft and CABG, 1 – allograft implantation after Bentall procedure. Mean interval between operations– 20,3 months. Endocarditis occured within a year after primary operation in 50%, and in 100% it was in active phase at the time of reoperation. Ten patients had aortic root abscesses with extensive destructions, 5 – intracardiac fistulas and 3 – mediastinitis with a fistula on suprasternal notch. In 2 patients the infection extended around temporary pacing wires, 1 patient had vegetations on the internal wall of dacron graft, the mechanical prosthesis was clear. RESULTS: Resternotomy – 3 (bleeding), 1 – side thoracotomy and lung stitching (massive pneumothorax due to violent lung emphysema), 2 – pacemaker implantation (complete AV-blockade). Recurrent infection was in 2 patients. In-hospital mortality 6,7% (acute heart failure), 15 patients were discharged. CONCLUSIONS: Allografts showed high resistance to infection in active prosthetic endocarditis with purulent abscesses and mediastinitis. Allografts’ shape and its implantation technique allows to apply it into destructed aortic root with deeply changed anatomy and to fill abscesses’ cavities with its tissues without hemodynamic deterioration.