Beating-heart left posterolateral thoracotomy for mitral valve replacement

Introduction and objectives: The case concerns a 34-year-old man with Marfan syndrome and Pectus Excavatum that has been previously operated on for an ascending aortic aneurysm and aortic regurgitation using the David I technique in 2007. The patient currently has severe mitral regurgitation due to rupture of the anterior chordae leaflet. The objective is to demonstrate that left posterolateral thoracotomy is a feasible alternative in certain selected cases for the treatment of mitral valve pathology.Methods: Given the anatomical characteristics of the patient, and previous cardiac surgery, posed the question of what would be the best approach for this case. After a review of the literature and expert consultations, it was decided to perform a mitral valve replacement via left posterolateral thoracotomy. To do this, after left posterolateral thoracotomy and cannulation at the level of the descending thoracic aorta and left common femoral vein (Seldinger), extracorporeal circulation was started. Given the impossibility of aortic clamping, it was decided to perform beating heart mitral valve replacement in a CO2 environment. To do this, a left atriotomy was performed and, using various recovery aspirators, an acceptable view of the mitral valve was achieved. I was decided to replace it, due to the technical difficulties that a valve repair would entail.Results: The mitral replacement was successfully performed by transoesophageal echocardiography.Conclusions: Left posterolateral thoracotomy may be an alternative for patients with concomitant pathologies that cause displacement of the heart towards the left hemithorax. Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cirugia Cardiovascular y Endovascular

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients