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Ascaso MAutor o CoautorSandoval EAutor o CoautorQuintana EAutor o Coautor

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Root-commando operation for multivalvular endocarditis and pericardiectomy.

Publicado en:Multimedia Manual Of Cardiothoracic Surgery : Mmcts / European Association For Cardio-Thoracic Surgery. 2020 - 2020-09-01 2020(), DOI: 10.1510/mmcts.2020.052

Autores: Fernández-Cisneros A; Ascaso M; Rovira I; Sandoval E; Quintana E

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Resumen

This video tutorial  presents the reconstruction of the intervalvular fibrosa and a triple valve replacement, due to prosthetic valve endocarditis, in a patient with previous chest irradiation and bicuspid aortic valve replacement. Constrictive pericarditis was also present since the original operation. A detailed step-by-step demonstration of the reconstruction of the intervalvular fibrosa and debridement of extensive prosthetic valve endocarditis with paravalvular root abscess are provided.  A secondary sternotomy was performed and, in the process, the ascending aorta was injured, with associated life-threatening bleeding. Manual compression was applied while peripheral cannulation and cardiopulmonary bypass were started. The bleeding was controlled with cooling and circulatory arrest and the ascending aorta was replaced with a Dacron graft. The intervalvular fibrosa was reconstructed using a folded pericardial patch.  Aortic root replacement with a cryopreserved homograft was performed and the mitral and tricuspid valves were replaced with tissue valve prostheses. A complete pericardiectomy was performed. The chest was left packed with cotton due to diffuse bleeding. At the time of the delayed chest closure, a permanent epicardial pacemaker was implanted.

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