Utilizing a sutureless valve for prosthetic valve endocarditis after aortic root replacement

TL;DR

A sutureless valve was successfully used to treat a prosthetic valve infection after aortic root replacement, reducing surgical risks and recovery time.

Contribution

The paper presents a novel application of a sutureless valve in reoperation for prosthetic valve endocarditis.

Findings

A sutureless valve implantation was effective in treating an infected bioprosthetic valve.

Preoperative CT scans accurately predicted the valve size for successful implantation.

The patient had an uneventful recovery with no recurrence of infection.

Abstract

Reoperation following aortic root replacement is associated with significantly high operative mortality. Etiologies related to infection are known to increase the operative mortality rate more than other etiologies. In such a clinical setting, a sutureless valve could lower the operative mortality by shortening the cardiac arrest and the operative time.

A 61-year-old male underwent emergent aortic root and total arch replacement with an open stent graft for acute type-A aortic dissection. A bioprosthetic valve was employed for aortic root replacement using the double-sewing ring technique. A fungal infection by Candida parapsilosis was postoperatively detected and improved with intravenous antifungal drug administration. However, he developed congestive heart failure one year later, and the blood cultures turned positive repeatedly for Candida parapsilosis. The prosthetic valve infection was suspected upon identifying vegetation on the bioprosthetic valve through transthoracic echocardiography. The computed tomography scan and operative findings confirmed that the infection was localized on the prosthetic valve. Consequently, the infected valve was removed without a vascular conduit, and a sutureless valve was implanted. The postoperative course was uneventful, without any evidence of recurrent fungal infection, and the patient was discharged on postoperative day 28.

Deploying a sutureless valve can facilitate a more straightforward and minimally invasive redo procedure. Preoperative computed tomography can predict the valve size, which is the key to implanting a sutureless valve successfully after the modified Bentall procedure.

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