Miami Minimally Invasive Valves
Joseph Lamelas, MD
Dedicated to the Advancement of Minimally Invasive Cardiac Surgery
October 6, 2013
Mini AVR, annular patch reconstruction for annular abcess

Prosthetic AV endocarditis is a difficult pathology to deal with.  In the past my first strategy would be to automatically use an AV homograft.  There are specific cases in which a patch can be placed in the healed abcess cavity and a bioprosthetic valve can be implanted.

I have enclosed pictures demonstrating a case in which I performed a minimally invasive AVR 4 years ago and the patient returned with AV endocarditis with a large annular abcess that encircled the left and non coronary infra-annular regions.  He was previously treated with IV antibiotics several times and now returned with severe paravalvular AI.  I performed a redo minimally invasive (right anterior thoracotomy),  removed the old valve,  debrided the annulus,  placed a large pericardial patch to cover a very large defect and then implanted a new valve. The valve sutures are placed through the patch and into the newly created annulus, which will be the superior aspect of the patch which incorporates aorta.

This is a very good solution to a potentially lethal problem.DSCN9260DSCN9265DSCN9273


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