211306 Valve replacement plus reconstruction of the annulus

/Han Lin(韩林，Dept Thorac Cardiac Surg，Changhai Hosp，2nd Mil Med Univ，Shanghai 200433)…∥Chin J Thorac Cardiovasc Surg.-2011，27(2)-90 ～92

ObjectiveTo investigate surgical technique and clinical outcomes of reconstruction of annulus and intervalvular fibrous body during valve replacements.Methods

Fifty-nine patients underwent reconstruction of annulus or intervalvular fibrous body during valve replacement.Indications for operation were small aortic annulus which may cause patient/prosthesis mismatch in 43，active infective endocarditis with abscess in periannulus tissue in 13，extensive calcification of aortic annulus in 2 and an active bleeding complication of aortic root after aortic and mitral valve replacement in 1.The reconstruction was done with fresh autologous pericardium.ResultsThe aortic clamping time in reconstruction of intervalvular fibrous body with double valve replacement was longer than that of regular double valve replacement.Four patients died in perioperative period，giving an overall in-hospital mortality of 6.7%.Postoperative complication were:re-sternotomy for bleeding in 2，Ⅲdegree A-V block in 2，respiratory dysfunction in 2，and acute renal failure in 2.Patients were followed up for 6 months by echocardiography study，and no periannular leakage was found.ConclusionReconstruction of annulus is an effective technique for patients with a small aortic annulus，extensive calcification of interventricular fibrous body and active infective endocarditis with abscess.Although the operative procedure is challenging and taking more time，the technique is safe and reproducible.5 refs，1 tab.