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Easy surgical explantation technique for sutureless Perceval S prosthesis, ‘lasso technique’: a case report

ABSTRACT:

Background

Due to structural valve deterioration of sutureless aortic prosthesis, there is a need for explantation of the prothesis. We introduce a surgical technique to explant sutureless aortic prosthesis, which has a self-expanding stent incorporated into the aortic wall.

Case presentation

An 82-year-old man who had undergone sutureless aortic valve replacement 6 years previously underwent redo-aortic and mitral valve replacement because of severe prosthetic aortic valve stenosis and mitral regurgitation. The sutureless prosthesis was explanted using ‘lasso technique’. The patient was discharged after 7 days without complications.

Conclusions

We presented a useful technique to explant a sutureless aortic prosthesis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13019-023-02160-1.

SUBMITTER: Kim Y

PROVIDER: S-EPMC9903434 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Project description:BackgroundWith the rapid expansion of transcatheter aortic valve replacement (TAVR), TAVR valve explantation is also increasing. Nevertheless, previous reports on Lotus Edge valve explantation are limited to only two reports, none of which include intraoperative videos. Therefore, we report the case of an older adult who underwent a 2-year-old Lotus Edge valve explantation, after developing prosthetic valve endocarditis (PVE) and aortic annular abscess, with a strong indication for a TAVR explantation and surgical aortic valve replacement (AVR).Case presentationAn 85-year-old male patient, who underwent TAVR with a 25-mm Lotus Edge valve for severe aortic stenosis 2 years ago, was referred to our hospital. He presented with a 1-month history of high-grade fever, refractory to oral antimicrobials and trifascicular heart block. Two sets of blood cultures were positive for Streptococcus dysgalactiae subspecies equisimilis, and transesophageal echocardiography revealed vegetation on the valve leaflets. Enhanced computed tomography scan showed thickening and enhancement of the aortic root and aorto-mitral continuity, with a small low-density area. Therefore, we diagnosed PVE. Subsequently, we planned AVR re-intervention and pacemaker implantation. The vegetation mass was attached to the aortic valve leaflet. We attempted to explant the valve while deforming it using forceps. The areas with abscess formation were easily dissected; however, the other areas were difficult to separate. Cold-saline irrigation softened the nitinol stent and enabled to dissect the prosthetic valve from the aortic wall. The infected aortic annulus was irrigated and then repaired. AVR using a 21-mm Avalus bioprosthetic valve and epicardial pacemaker lead implantation were simultaneously performed. Postoperative echocardiography confirmed that the prosthetic valve function was favorable, and the patient was transferred to a rehabilitation hospital after 6 weeks of intravenous antimicrobial therapy.ConclusionThe Lotus Edge valve is difficult to remove due to its fixation after deployment and strong adhesion, but the use of cold water may be effective in facilitating its removal.