Reoperative Aortic Valve Replacement for Structural Valve Deterioration through a Lower Hemisternotomy after a Previous Bentall Procedure in a Patient with Tracheostomy

Kaori Katsumata, Yujiro Kawai, Tsutomu Ito, Hideyuki Shimizu

Research output: Contribution to journalArticlepeer-review

Abstract

Patients with tracheostomy who undergo a full sternotomy have an increased risk of mediastinitis and sternal infection. This report describes a reoperative aortic valve replacement (re-AVR) for structural valve deterioration (SVD) through a lower hemisternotomy. This procedure was performed on a 71-year-old man with a tracheostomy who had previously undergone a Bentall procedure with a bioprosthetic valve to replace an enlarged ascending aortic aneurysm. Comorbidities included chronic renal failure requiring hemodialysis. Fourteen months after the Bentall procedure, the patient presented with sudden dyspnea and was transferred to another hospital. Upon suffering acute heart failure, the patient required mechanical ventilation and was transferred to our hospital for intubation. The patient subsequently developed severe pneumonia. As a result of prolonged ventilation, the patient underwent tracheostomy and was administered antibiotic medication (piperacillin/tazobactam) for pneumonia. Echocardiography revealed severe aortic regurgitation caused by SVD. There was a risk that a full sternotomy in a patient with tracheostomy could cause mediastinitis; therefore, we performed a re-AVR through a lower hemisternotomy (second T incision). The re-AVR surgery proceeded without complications, and the bioprosthetic valve was removed while preserving the vascular graft from the previous Bentall procedure. The postoperative course was uneventful, and the patient was discharged from hospital 31 days after the tracheostomy was closed. The success of this procedure demonstrates the viability of re-AVR through a lower hemisternotomy in patients with SVD who are at risk of additional surgical complications.

Original languageEnglish
Pages (from-to)21-25
Number of pages5
JournalKeio Journal of Medicine
Volume72
Issue number1
DOIs
Publication statusPublished - 2023

Keywords

  • Bentall procedure
  • lower hemisternotomy
  • reoperative aortic valve replacement
  • tracheostomy

ASJC Scopus subject areas

  • General Medicine

Fingerprint

Dive into the research topics of 'Reoperative Aortic Valve Replacement for Structural Valve Deterioration through a Lower Hemisternotomy after a Previous Bentall Procedure in a Patient with Tracheostomy'. Together they form a unique fingerprint.

Cite this