Long-Term Results of Aortomitral Fibrous Body Reconstruction With Double-Valve Replacement Su Wan Kim, MD, Pyo Won Park, MD, PhD, Wook Sung Kim, MD,

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Long-Term Results of Aortomitral Fibrous Body Reconstruction With Double-Valve Replacement Su Wan Kim, MD, Pyo Won Park, MD, PhD, Wook Sung Kim, MD, PhD, Kiick Sung, MD, PhD, Young Tak Lee, MD, PhD, Tae-Gook Jun, MD, PhD, Dong Seop Jeong, MD The Annals of Thoracic Surgery Volume 95, Issue 2, Pages 635-641 (February 2013) DOI: 10.1016/j.athoracsur.2012.09.021 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Double-valve replacement with aortomitral fibrous body reconstruction combined with aortic and mitral annular reconstruction using bovine pericardial patch. (A) Mitral annular reconstruction with bovine pericardium (arrow) after excision of prosthetic valves and division of the aortomitral fibrous body. (B) Circumferential aortic annular reconstruction (arrow). (C) Mitral valve suture for prosthetic valve implantation (arrow). (D) Double-layered bovine pericardium for aortomitral fibrous body reconstruction. Lower patch (arrow up) was used to repair the dome of the left atrium and upper patch (arrow down) to widen the aortic root. The aortic tissue valve (*) and mitral tissue valve (**) were already implanted. The Annals of Thoracic Surgery 2013 95, 635-641DOI: (10.1016/j.athoracsur.2012.09.021) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Detailed schematic drawings show aortomitral fibrous body reconstruction. (A) After a prosthetic mitral valve is fixed to posterior mitral annulus, (B) several everting sutures with Teflon pledget or (B') continuous 3-0 polypropylene running sutures secure the anterior part of the prosthetic mitral valve to the central portion of the bovine patch (width, 3 to 3.5 cm). These sutures divide the patch into upper (length, 5 to 6 cm) and lower (length, 3 to 4 cm) bovine pericardial patches. (C) The upper patch is used to reconstruct the aortic root with 5-0 polypropylene sutures, and the lower patch is use to reconstruct the roof of the left atrium with continuous 4-0 polypropylene sutures. (D) Both transitional zones of the central fibrous body are reinforced by Teflon-pledgeted sutures that penetrate the patch from outside to inside. (E) The prosthetic aortic valve is subsequently secured to the pericardial patch, which is approximately 1 cm above the mitral suture line. The Annals of Thoracic Surgery 2013 95, 635-641DOI: (10.1016/j.athoracsur.2012.09.021) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier overall survival curves for patients with (solid line) and without (dotted line) infective endocarditis. The overall survival rate was 80.8% at 1 year and 74.6% at 5 years in the patients with preoperative infective endocarditis. The survival rates were not statistically different from the survival rates of the patients without infective endocarditis (p = 0.766). The Annals of Thoracic Surgery 2013 95, 635-641DOI: (10.1016/j.athoracsur.2012.09.021) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) The freedom from reoperation rate was 95.5% at 1 year and 84.8% at 5 years. (B) The freedom from infective endocarditis rate was 94.7%. at 1 and 5 years. The Annals of Thoracic Surgery 2013 95, 635-641DOI: (10.1016/j.athoracsur.2012.09.021) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions