A standardized approach to treat complex aortic valve endocarditis: a case series

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Prosthetic Valve Surgery

Background:

• Surgical treatment of complicated aortic valve endocarditis with paravalvular abscesses presents significant challenges.
• A standardized surgical approach is needed for these complex cases.

Purpose of the Study:

• To demonstrate a standardized surgical approach using stentless bioprostheses for aortic valve endocarditis complicated by paravalvular abscess formation.
• To evaluate the feasibility and outcomes of this standardized approach.

Main Methods:

• Sixteen patients with aortic valve endocarditis and paravalvular abscesses (native and prosthetic valves) were treated with stentless bioprostheses.
• The procedure involved thorough debridement, aortic root replacement with coronary reimplantation, and correction of associated pathologies.

Main Results:

• Successful treatment was achieved in all complex patients using stentless bioprostheses for aortic root replacement.
• Radical surgical debridement and anatomical reconstruction were feasible.
• Despite high predicted operative mortality, in-hospital and 30-day mortality rates were favorable (18.8% and 12.5%).

Conclusions:

• Repair of aortic valve endocarditis with paravalvular abscess using stentless bioprostheses is a valuable option for native and prosthetic valves.
• This standardized approach offers high success rates for debridement and comparable outcomes to homograft repair.
• Utilizing a single type of prosthesis simplifies logistics and reduces costs.