A new method for coronary artery reconstruction in patients with recurrent aortic prosthetic valve endocarditis and an inaccessible coronary arterial system.

A new approach to the problem of recurrent infection of an aortic valve prosthesis in a patient with an inaccessible coronary arterial system is presented. The coronary arteries were reconstructed by anastomosing a looped ringed-PTFE graft to the left and right coronary ostia within the aorta, and the graft was withdrawn from the aorta just above the ostia. Then the top of the looped graft was anastomosed to the aorta above a translocated aortic prosthesis. This procedure is most likely to be useful in the treatment of recurrent aortic prosthetic valve endocarditis which has dense pericardial adhesion secondary to multiple cardiac operations. Aortic prosthetic valve endocarditis frequently is associated with a paravalvular ring abscess which may destroy the normal annulus. In these cases, translocating the aortic valve to the ascending aorta, and placing saphenous vein bypass grafts to the right and the left anterior descending coronary artery may be required. However, the coronary arteries may not be accessible following multiple operations. The following case illustrates a new solution to the problem how to translocated the aortic valve and reconstruct the coronary arteries in a patient with an infected aortic root and inaccessible coronary arteries.