Redo Aortic Root Replacement and Tricuspid Repair After Prosthetic Valve Endocarditis

This fifty-five-year-old, 125 kg patient had a previous aortic valve replacement and presented with endocarditis with heart failure with a CVP of 30. 

It was determined unsafe to give antegrade cardioplegia due to the concern over embolizing endocarditis debris down the coronary arteries, so percutaneous femoral vein cannulation and SVC venous cannulation were performed. A Cosgrove clamp was then placed above the IVC in the chest and the right atrium was opened. A retrograde cannula was placed directly into the coronary sinus to give cardioplegia. 

The previous valve was placed with COR-KNOTS, so every metal COR-KNOT had to be removed. The valve was removed, and all debris was then resected to reveal a complete aortoventricular discontinuity. The left main button was then created, which proved difficult, and then the right coronary button was created. 

The aortic root replacement used an Edwards KONECT device, which was sutured in place with pledgeted interrupted sutures. Then, the left and right coronary buttons were completed, along with the distal anastomosis of the aorta. 

A tricuspid annuloplasty was then performed with interrupted horizontal pledgeted mattress sutures and a 30 mm annuloplasty ring. The right atrium was then closed and the operation was completed.

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