Reconstruction of Mitral-Aortic Continuation in the Surgery of repeated Interventions

Alexander A. Makushin, Vladimir A. Mironenko, Eleonora A. Kuts, Arslan S. Karamatov, Lyubov V. Chegrina, Gennadiy V. Yudin, Tatyana I. Kosareva, Iuri M. Archaia

A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Aim: to evaluate the outcomes of reoperations with mitral-aortic continuation reconstruction

Methods: During the period October, 2010- February, 2017 10 patients underwent repeated mitral-aortic continuation reconstruction with implantation of aortic valve prosthesis or its replacement with the time frames ranging 1 month-20 years since the previous operation.

The operated group included 7 men and 3 women at the age 20-66 years (mean age–39 years). One patient aged 9 years underwent primary intervention with open aortic comissurotomy; one case was cryopreserved allograft implantation in the presence of active endocarditis with aortic root boring; 6 cases–implantation of aortic prosthesis; one patient first had mitral valve prosthesis implantation with plasty of the tricuspid valve, then replacement of the prosthesis in the presence of active infectious endocarditis; implantation of mitral-aortic prosthesis had been previously performed in one case.

All interventions were carried out with mitral–aortic continuation reconstruction according to the pathomorthology due to either destruction as a result of the infectious process, or necessary anatomy reconstruction followed by prosthesis implantation in accordance to patient’s surface area. Xenopericardium was used as the material for reconstruction.

Results: At the hospital one patient died from multiple organ failure due to initial severity of the disease. The main group of patients was discharged within 10-30 days since the operation had been performed; their hemodynamic indicators were satisfactory, with no signs of prosthetic or paraprosthetic leakage dysfunction. We observed 2 cases with aortic root reconstruction caused by infectious process in one case and malignant calcinosis in the other, with full rehabilitation of the functional class and echo parameters in 3 years.

Conclusions:

1) Mitral-aortic continuation reconstruction allows repairing the aortic root with different etiology and pathomorthology of the disease including simultaneous implantation of mitral valve prosthesis.

2) Xenopericardium can be recommended as the preferable material in the massive reconstruction of mitral-aortic continuation and the aortic root in general.