Surgery for aortic valve endocarditis: treatment options for aortic abscess

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis Management
• Prosthetic Valve Surgery

Background:

• Infective endocarditis presents diverse anatomical challenges, particularly with aortic ring abscesses and intracardiac fistulae, complicating surgical repair.
• Surgical strategies for infective endocarditis have evolved with techniques for radical cleaning, biological glues, and novel valve replacements.
• Reoperation for aortic position prostheses is complex, especially when associated with abscesses and fistulae.

Purpose of the Study:

• To present a new surgical treatment option for aortic abscesses in selected cases.
• To demonstrate the use of an infra-coronary valved conduit for complex aortic abscesses.
• To evaluate the feasibility of this technique in patients with reoperative aortic valve prostheses.

Main Methods:

• The infra-coronary valved conduit technique was applied in three patients with aortic abscesses.
• Two patients received a valved conduit with a mechanical prosthesis; one received a biological prosthesis.
• Associated procedures included mitral valve replacement in one patient and tricuspid valvoplasty in another.

Main Results:

• Surgical and early postoperative progression was satisfactory, with all three patients discharged from the Intensive Care Unit.
• One patient died during hospitalization due to severe preoperative comorbidities (esophageal varices, hepatic involvement).
• The remaining two patients demonstrated good late postoperative outcomes.

Conclusions:

• The infra-coronary valved conduit is a viable alternative for treating aortic abscesses.
• This technique is particularly suitable for cases with extensive aortic ring involvement and mitro-aortic continuity issues.
• It offers an additional therapeutic option for complex infective endocarditis scenarios.