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Left Ventricular Outflow Reconstruction With The Pericarbon Freedom Stentless Bioprosthesis For Destructive Aortic Endocarditis
Sandro Sponga, Cristian Daffarra, Deasy Pavoni, Igor Vendramin, Enzo Mazzaro, Giorgio Guzzi, Ugolino Livi.
Udine University Hospital, Udine, Italy.

OBJECTIVE: The best valve substitute for valve endocarditis has not yet been identified. We report the results of the Pericarbon Freedom valve used to reconstruct the left ventricular outflow tract in destructive endocarditis of either aortic native valves or valve prostheses, complicated by periannular abscesses and root disarrangement
METHODS: Since August 2007, 37 patients (mean age 68±12, 76% males, Logistic Euroscore 19.6±8.8, NYHA class≥ 3 in all cases) have undergone left ventricular outflow tract reconstruction with a Pericarbon Freedom stentless bioprosthesis. Seven patients (19%) were in septic or cardiogenic shock preoperatively, 16 patients (43%) suffered from moderate or severe aortic regurgitation. Ten patients (27%) experienced preoperative systemic embolizations. Thirty-three cases (89%) were valve redos and 8 patients (22%) had concomitant procedures. Cusp perforations were found in 8 patients (22%); discontinuity of the ventriculoaortal junction was detected in 11 patients (29%) and in 32 patients (86%) abscesses involved more than 2/3 of the annulus; Mean follow-up was 26±23 months.
RESULTS: One patient (3%) died at 30-day because of multi organ failure and septic shock. Actuarial survival was 85±6% at 1 year, 76±8% at 3 and 5 years, respectively. Postoperatively, 10 patients (27%) required pacemaker implantation for atrioventricular block and 20 patients (54%) developed renal failure. One drug addicted patient (3%) developed endocarditis relapse treated with antibiotic therapy, and 1 (3%) showed a mild paraprosthetic aortic leak. No patient needed reoperation. At the last echocardiographic evaluation, mean gradient, peak gradient and left ventricular ejection fraction were 8.1±5.0 mmHg, 15.7±7.3 mmHg and 63.2±9.6%, respectively.
CONCLUSIONS: The Pericarbon
Freedom prosthesis proves to be an excellent substitute in cases of destructive aortic valve endocarditis with good hemodynamic performances and low risk of relapses. It is promptly available in different sizes, easy to implant and its large inflow “skirts” can be used to reproduce the result obtained with the autologus pericardium usually employed to cover the abcesses. The technique of inverting the prosthesis into the left ventricle seems to facilitate the surgical approach by allowing a deeper and better sealing running suture

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