J.Jpn. Surg. Soc.. 110(1): 7-11, 2009

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Feature topic

SURGERY FOR AORTIC VALVE ENDOCARDITIS

Infective endocarditis is a life-threatening disease that should be diagnosed based on Duke's criteria as early as possible. A positive blood culture and echocardiographic findings, particularly those of a transesophageal echocardiogram, play a pivotal role in the process of confirming a diagnosis. Medical treatment using appropriate antibiotics against the identified microorganism is of primary importance, although infective endocarditis is often accompanied by intracardiac or extracardiac complications and must be converted to surgery. The timing of surgery for patients with brain complications is crucial but still controversial because the usage of heparin for cardiopulmonary bypass (CPB) may cause the complications to deteriorate. We demonstrated that a novel CPB strategy with nafamostat mesilate as an anticoagulant may be potentially safe and useful in preventing deterioration of recent intracranial hemorrhage. Destructive aortic valve endocarditis causes the development of left ventricular-aortic discontinuity. In the past 8 years, 9 patients with left ventricular-aortic discontinuity underwent aortic root replacement in our institution. Radical debridement of the aortic root abscess was performed in all cases, followed by aortic root replacement with a pulmonary autograft (Ross procedure) or a stentless aortic root xenograft. No mortality was observed during hospitalization and follow-up. Freedom from major adverse cardiac events was noted in 67% of the patients at 5 years.

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