Twenty-five years' experience with root remodeling and bicuspid aortic valve repair.

Background: Bicuspid aortic valves may be associated with ascending aortic aneurysm, or develop severe aortic regurgitation with variable aortic dilatation. If aortic dilatation involves the root, valve-preserving root replacement is a treatment option, and we prefer root remodeling for this purpose. The objective of this study is to review our experience encompassing 25 years. Methods: Between November 1995 and August 2021, 472 patients (429 male; age 9-80 years; mean 48±13 years) were treated by bicuspid aortic valve repair and root remodeling. Aortic regurgitation was present in 322 cases. The primary indication for surgery was aortic regurgitation (n=317), aortic aneurysm (n=143) or acute type A aortic dissection (n=12). In 271 instances, a suture annuloplasty was added. Cusp calcification was present beyond the raphe in 80 cases, and a pericardial patch was used for partial cusp replacement in 44 cases. Follow-up was 92.8% complete with a mean of 71±68 months (median 61 months). Results: Hospital mortality was 0.4% and survival at 20 years was 76.9%. Reoperation was necessary for recurrent aortic regurgitation in 26 patients; nine patients underwent reoperation for stenosis. The overall freedom of reoperation was 90.5% after ten years and 76.6% after 20 years. Annuloplasty was associated with a higher proportion of competent aortic valves at discharge (P=0.001), and had no effect on ten-year freedom from reoperation. The use of a pericardial patch for cusp repair was a predictor for reoperation (P=0.003). The presence of cusp calcification was a predictor for the development of aortic stenosis and reoperation (P=0.032). Conclusions: Bicuspid aortic valve repair combined with root remodeling leads to excellent ten- and 20-year results. Cusp calcification and partial cusp replacement are associated with an increased probability of valve failure requiring reoperation.

Outbreak of Burkholderia cepacia complex infections associated with contaminated octenidine mouthwash solution, Germany, August to September 2018.

Three German patients developed nosocomial pneumonia after cardiac surgery and had Burkholderia cepacia complex detected in respiratory specimens. Two patients died of septic multi-organ failure. Whole-genome sequencing detected genetically identical B. cepacia complex strains in patient samples, from a batch of octenidine mouthwash solution, which had been used for nursing care, as well as in samples obtained from the manufacturer during production. Contamination of medical products during manufacturing may lead to international outbreaks.

Two decades of experience with root remodeling and valve repair for bicuspid aortic valves.

OBJECTIVE: Bicuspid aortic valve anatomy is associated with ascending aortic aneurysm in approximately 50% of individuals and may lead to severe aortic regurgitation with aortic dilatation. Both entities may be treated by valve repair and root remodeling. The objective was to review the cumulative experience of 20 years. METHODS: Between November 1995 and December 2015, 357 patients (324 male; age 10-80 years; mean, 49 ± 13 years) underwent combined bicuspid aortic valve repair and root remodeling. Aortic regurgitation was relevant in 265 cases; the main indications for surgery were aortic regurgitation (n = 241), aortic aneurysm (n = 102), and acute dissection (n = 9). In 225 instances, a suture annuloplasty was added. Cusp calcification was present beyond the raphe in 52 cases, and an autologous pericardial patch was implanted for partial cusp replacement in 39 cases. All patients were followed. Follow-up was 97.8% complete with a mean of 57 ± 51 months (median, 39 months). RESULTS: Two patients died (hospital mortality 0.6%), and survival at 15 years was 81%. Reoperation became necessary for recurrent aortic regurgitation in 24 patients; 6 patients underwent reoperation for stenosis. Cumulative incidence of reoperation at 15 years was 21.7%. Cusp calcification and the use of a pericardial patch for cusp reconstruction were associated with time to reoperation (P = .002). CONCLUSIONS: Repair of the bicuspid aortic valve combined with root remodeling leads to excellent 10- and 15-year results. Cusp calcification and the need for partial cusp replacement are associated with valve failure.

Successful thrombolysis after pulmonary endarterectomy.

We report the case of a 51-year-old woman who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. On postoperative day 1 she developed bilateral pulmonary thrombosis due to preoperatively undiagnosed heparin-induced thrombocytopenia. Systemic thrombolytic therapy with alteplase on postoperative days 5 and 6 resulted in marked clinical improvement. To our knowledge this is the first report of successful thrombolysis of pulmonary thrombosis due to heparin-induced thrombocytopenia after pulmonary endarterectomy.