Sutureless aortic valve replacement in a calcified homograft combined with mitral valve replacement
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CASE REPORT
Open Access
Sutureless aortic valve replacement in a calcified homograft combined with mitral valve replacement Ferdi Akca*, Kayan Lam, Ibrahim Özdemir and Erwin Tan
Abstract Background: Aortic valve replacement in a patient with an aortic homograft can be very challenging, especially when concomitant mitral valve surgery needs to be performed. Case presentation: We report a case of implantation of a sutureless aortic valve bioprosthesis combined with mitral valve replacement in a patient with a severely calcified aortic homograft where conventional valve replacement was technically unfeasible. Conclusions: We believe that sutureless AVR is a viable option especially for young patients with a high surgical risk where conventional valve replacement cannot be achieved. Keywords: Sutureless aortic valve, Aortic valve replacement, Homograft, Mitral valve replacement
Background Structural valve deterioration occurs regularly in patients with an aortic root homograft and could require the need for reoperation [1]. This procedure could be technically very challenging with long aortic cross-clamp times, since severe calcifications of the annulus are often present [2]. Furthermore, the operative risk increases with age, multiple comorbidities and the need for concomitant valve surgery. Sutureless aortic valve replacement (AVR) has emerged as a promising technique with good hemodynamic properties and is a viable option for patients with a high surgical risk [3]. Initially, concomitant mitral valve surgery was not recommended with sutureless aortic bioprostheses because of the potential risk of interference at the level of the aorto-mitral continuity. However, more and more reports demonstrate the feasibility of concomitant mitral valve surgery during sutureless AVR [4]. For patients with an aortic root homograft needing reoperation data are scarce. We report a unique case of a patient with a severely calcified homograft who needed concomitant mitral valve replacement (MVR) where conventional AVR was * Correspondence: [email protected] Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
technically unfeasible and implantation of a sutureless aortic bioprosthesis was performed.
Case presentation A 55-year old man was hospitalized for congestive heart failure due to combined severe stenosis and regurgitant aortic valve disease. The patient’s medical history included rheumatic heart disease requiring a 23 mm aortic root homograft implantation 21 years earlier. The patient was referred to our center for surgical intervention. Transthoracic echocardiography showed severe aortic valve regurgitation (pressure half time < 200 ms), moderate aortic stenosis (mean gradient 38 mmHg), left ventricular ejection fraction of 0.50 and a moderate mitral regurgitation and stenosis. Coronary angiography showed no significant stenosis, however aortic calcifications were visible and a computed tomography (CT) scan was performed
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