Mechanical Prosthetic Valve Sparing for Aortic Root Abscess Complicated by Infective Endocarditis

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Prosthetic Valve Management

Background:

• Aortic root abscess with infective endocarditis of mechanical prosthetic valves carries high morbidity and mortality.
• Traditional management often necessitates valve replacement, increasing complexity and operative time.

Purpose of the Study:

• To evaluate the efficacy and safety of a valve-sparing technique for managing aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve.
• To assess the midterm outcomes of this innovative surgical approach.

Main Methods:

• Retrospective analysis of 41 patients undergoing surgery for aortic root abscess and mechanical prosthetic valve endocarditis.
• Application of a valve-sparing technique in 20 selected patients, involving abscess drainage, debridement, and Gelweave patch repair.
• Assessment of early and midterm outcomes, including mortality, valve function, and paravalvular leak.

Main Results:

• The valve-sparing technique was successfully applied in 20 patients, preserving the native mechanical aortic valve.
• Early mortality was 10% (2 patients) due to low cardiac output syndrome and multisystem organ failure.
• At 1-year follow-up, 90% of surviving patients were symptom-free with well-functioning valves and no paravalvular leaks.

Conclusions:

• The described valve-sparing technique is a safe and effective option for select patients with aortic root abscess and mechanical prosthetic valve endocarditis.
• This approach reduces operative time and is associated with encouraging midterm results and acceptable mortality rates.
• Preservation of the mechanical aortic valve can be achieved, potentially improving patient outcomes.