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Total Reconstruction Of Ventriculo-aortic Junction Using An Autologous Conduit And A Stentless Pericardial Aortic Bioprosthesis
Giuseppe Zattera,
Pasquale Totaro, Alessandro Mazzola.
IRCC Foundation Hospital San Matteo, Pavia, Italy.

Objective Treatment of acute infective endocarditis remains a surgical challenge expecially in presence of large disruption of the sub annular apparatus when a complete obliteration of the abscess cavity before valve replacement is mandatory. Here we present an original technique which we have introduced for the treatment of acute endocarditis with complete disruption of ventrico-aortic junction (VAJ).
Materials and Methods Autologous conduit can be prepared using two different techniques: in the standard procedure a large patch of autologous pericardium is harvested following midline sternotomy . Free margins of the pericardial patch are then sutured together to create the cylinder of autologous conduit (Fig 1a-b); Alternatively (ie. in case of REDO patients) the first portion of common pulmonary trank (without pulmonary artery) can be harvested and used as autologous conduit.
Once the conduit is prepared, the two techniques are similar. Once the heart is arrested, aorta is opened and the valve excised. Subvalvular apparatus is inspected and the state of VAJ assessed. The VAJ is then reconstructed suturing the autologous cylinder below the area of disruption and above the aortic annulus (Fig 1c). Reconsruction is completed with the implantation of a solo pericardial stentless bioprosthesis (Fig 1d) above the level of the distal anastomosis of the autologous cylinder (Fig 1e).
Results Both the described techniques allowed, in our series, complete AVJ reconstruction with full recovery in all patients. No case of postoperative complications related to the surgical technique were reported. Furthermore any recurrence of endocarditis was reported.
Conclusions Autologous reconstruction of ventriclolo-aortic junction is suitable and could improve postoperative outcomes. Such techniques allow indeed a complete debridment and exclusion of all the infected area leaving the supra-annular area intact where Solo pericardial bioprosthesis could be easily implanted.

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