A case report of using an aortomitral homograft in a patient with infective endocarditis: surgical technique and immediate outcomes
Abstract
Surgical treatment of infective endocarditis remains challenging when the intervalvular fibrous body with the resultant abscess is involved. The removal of the fibrous body implies the resection of at least portion of the infected annulus of the aortic and mitral valves, complicating the reconstruction. In addition, infection of the intervalvular fibrous body is often associated with the infection of other cardiac structures that should be removed. The implantation of a monobloc aortomitral homograft is a feasible alternative option that provides sufficient tissue to secure the reconstruction. It adheres well to the tough tissues involved in the reconstruction, is quite resistant to recurrent infection, hemodynamically effective and does not require anticoagulation therapy.
About the Authors
R. N. Komarov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Aortic and Cardiovascular Surgery
Russian Federation
Russian Federation
Komarov Roman N., M.D., Ph.D., Professor, Head of the Department of Cardiovascular Surgery
6-1, Bolshaya Pirogovskaya St., Moscow, 119991
A. V. Tsaregorodtsev
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Tsaregorodtsev Anton V., student at the Department of General Medicine
1, Ostrovityanova St., Moscow,117997
M. I. Tkachev
I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Aortic and Cardiovascular Surgery
Russian Federation
Russian Federation
Tkachev Maxim I., M.D., assistant at the Department of Cardiovascular Surgery
6-1, Bolshaya Pirogovskaya St., Moscow, 119991
V. A. Savina
I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Aortic and Cardiovascular Surgery
Russian Federation
Russian Federation
Savina Victoria A., student at the Department of General Medicine
6-1, Bolshaya Pirogovskaya St., Moscow, 119991
L. R. Baziyants
I.M. Sechenov First Moscow State Medical University (Sechenov University), Clinic of Aortic and Cardiovascular Surgery
Russian Federation
Russian Federation
Baziyants Lusine R., student at the Department of General Medicine
6-1, Bolshaya Pirogovskaya St., Moscow, 119991
References
1. Kim JY, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Long-Term Outcomes of Homografts in the Aortic Valve and Root Position: A 20-Year Experience. Korean J Thorac Cardiovasc Surg. 2016;49(4):258-263. doi:10.5090/kjtcs.2016.49.4.258
2. Lima B, Chamogeorgakis T, MacHannaford JC, Rafael A, Gonzalez-Stawinski GV, Lima Md B. How to Do It: The Commando Operation for Reconstruction of the Fibrous Skeleton with Double Valve Replacement. Heart Surg Forum. 2016;19(6):E308-E310. doi:10.1532/hsf.1514
3. Hosseini MT, Kourliouros A, Sarsam M. Double-Valve Endocarditis Homograft and Patch Repair. The Annals of Thoracic Surgery. 2009;88(5):1708-1709. doi:10.1016/j.athoracsur.2009.02.041
4. Chocron S, Buklas D, Taberlet C, Kaili D, Falcoz PE, Etievent JP. Monobloc aorto-mitral homograft: report of two cases. Ann Thorac Surg. 2007;84(4):e14-e16. doi:10.1016/j.athoracsur.2007.06.058
5. Obadia JF, Raisky O, Sebbag L, Chocron S, Saroul C, Chassignolle JF. Monobloc aorto-mitral homograft as a treatment of complex cases of endocarditis. The Journal of Thoracic and Cardiovascular Surgery. 2001;121(3):584-586. doi:10.1067/mtc.2001.111375
6. Obadia JF, Hénaine R, Bergerot C, et al. Monobloc aortomitral homograft or mechanical valve replacement: A new surgical option for extensive bivalvular endocarditis. The Journal of Thoracic and Cardiovascular Surgery. 2006;131(1):243-245. doi:10.1016/j.jtcvs.2005.05.058
7. Chernov II, Ekimov SS, Motreva AP, et al. Treatment of prosthetic endocarditis using aortic-mitral homograft. Clinical and Experimental Surgery. 2015;3(9):70-72. (In Russ.)
8. Aliev ER, Chernov II, Tokarev AV, et al. The use of aortal-mitral monobloc homografts for treating infective endocarditis. The Russian Journal of Cardiology. 2022; S7(27):25-25.
9. Pomar JL, Mestres CA. Role of Atrioventricular Homograft Valves in Atrioventricular Valve Replacement. Asian Cardiovasc Thorac Ann. 1996;4(2):122-125. doi:10.1177/021849239600400219
10. Komarov RN, Tkachev MI, Ismailbaev AM, et al. Case report: Autopericardial aortic valve replacement and mitral homograft implantation in a patient with ankylosing spondylitis. International Journal of Surgery Case Reports. 2023;104:107911. doi:10.1016/j.ijscr.2023.107911
11. Navia JL, Al-Ruzzeh S, Gordon S, et al. The incorporated aortomitral homograft: a new surgical option for double valve endocarditis. J Thorac Cardiovasc Surg. 2010 Apr;139(4):1077-81. doi: 10.1016/j.jtcvs.2009.05.017. PMID: 19660273.
12. Ali M, Iung B, Lansac E, Bruneval P, Acar C. Homograft replacement of the mitral valve: eight-year results. J Thorac Cardiovasc Surg. 2004 Oct;128(4):529-34. doi: 10.1016/j. jtcvs.2003.11.076. PMID: 15457153.
Review
For citations:
Komarov R.N., Tsaregorodtsev A.V., Tkachev M.I., Savina V.A., Baziyants L.R. A case report of using an aortomitral homograft in a patient with infective endocarditis: surgical technique and immediate outcomes. Minimally Invasive Cardiovascular Surgery. 2023;2(2):58-64. (In Russ.)
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