Aortic root abscess complicating bacterial endocarditis. Demonstration by computed tomography.

Purpose. The optimal surgical strategy of aortic root in acute type A aortic dissection (ATAAD) is controversial. The aim of this study was to evaluate the feasibility and safety of “Sleeve” sinus Valsalva repair for AAD limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia. Methods: From Sep 2016 to Mar 2019, 20 patients with AAD involving non-coronary sinus or partial left and right coronary sinus Valsalva underwent “Sleeve” sinus Valsalva repair . Multi slice spiral computed tomography angiography (MSCT) and three dimensional reconstruction were routinely performed in all patients to assess the maximal diameters of each segment of the aorta. Results. There was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 1 patient and no bleeding was related to the proximal anastomosis. The post-operative drainage was 390.5±229.3mL. During the following-up, the echocardiography showed the normal sinus of Valsalva and aortic valvular function. The computed tomography angiography showed normal aortic root without endovascular leak or dissection around the sinus of Valsalva. All patients were free from reoperation. Conclusions. “Sleeve” sinus Valsalva repair with Dacron patch for aortic dissection limited to the non-coronary sinus or partial left and right coronary sinus without involvement coronary artery ostia was technically feasible and safe.

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Surgery for Aortic Root Abscess: A 15-Year Experience

Texas Heart Institute Journal ◽

10.14503/thij-14-4747 ◽

2016 ◽

Vol 43 (1) ◽

pp. 20-28 ◽

Cited By ~ 18

Author(s):

Kaan Kirali ◽

Sabit Sarikaya ◽

Yucel Ozen ◽

Hakan Sacli ◽

Eylul Basaran ◽

...

Keyword(s):

Valve Replacement ◽

Aortic Root ◽

Survival Rates ◽

Prosthetic Valve Endocarditis ◽

Composite Graft ◽

Left Ventricular ◽

Surgical Reconstruction ◽

Pericardial Patch ◽

Aortic Root Abscess

Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit.

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