Left ventricular outflow tract reconstruction and translocation of the aortic valve for annular erosion: Early and midterm outcomes

ObjectiveAortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement without endocarditis, and its surgical management is challenging. We present the early and midterm results of a technique for left ventricular outflow tract and aortic root reconstruction with a polyester tube graft and translocation of the aortic valve and coronary arteries.MethodsA polyester tube graft is placed into the left ventricle and sutured to the left ventricular outflow tract below the area of erosion. The graft is then everted and sutured to a composite graft. Interposition polyester grafts from the coronary arteries are attached to the composite graft above the valve. This technique has been used in 12 cases. All but 1 patient had previously undergone aortic root or aortic valve replacement, and 4 had endocarditis of prosthetic (n = 2) or aortic allograft (n = 2) valves.ResultsThere were no in-hospital deaths. There was 1 early death from pulmonary embolism at 1 postoperative month and 2 late deaths at 15 and 64 postoperative months, both resulting from heart failure. The remaining 9 patients are alive at 3 to 132 postoperative months. Actuarial 5-year survival is 75%.ConclusionsLeft ventricular outflow tract reconstruction with translocation of the aortic valve and coronary arteries for annular erosion is a useful technique that safely excludes the area of annular erosion and eliminates left ventricular outflow tract obstruction. The procedure can be safely performed with satisfactory early outcomes and 5-year survival.