Utilizing a sutureless valve for prosthetic valve endocarditis after aortic root replacement

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Reoperation after aortic root replacement carries high mortality, particularly with infection.
• Prosthetic valve endocarditis presents a significant challenge in managing aortic root pathology.
• Shorter operative times and cardiopulmonary bypass duration are crucial for improving outcomes in complex cardiac surgeries.

Purpose of the Study:

• To evaluate the feasibility and outcomes of using a sutureless valve in a patient with prosthetic valve endocarditis after aortic root replacement.
• To assess the potential benefits of a sutureless valve in reducing operative time and complexity during redo aortic root surgery.
• To highlight the role of advanced imaging and surgical techniques in managing complex cardiovascular infections.

Main Methods:

• A case presentation of a 61-year-old male with acute type-A aortic dissection undergoing aortic root and total arch replacement.
• Management of postoperative fungal endocarditis (Candida parapsilosis) with antifungal therapy.
• Redo aortic root replacement involving removal of the infected bioprosthetic valve and implantation of a sutureless valve.

Main Results:

• Successful implantation of a sutureless valve after removal of an infected bioprosthetic valve.
• Uneventful postoperative recovery with no evidence of recurrent infection.
• Patient discharged on postoperative day 28, indicating successful management of a complex redo procedure.

Conclusions:

• Sutureless valves offer a simpler and less invasive option for redo aortic root procedures.
• Preoperative computed tomography is essential for accurate valve sizing, crucial for successful sutureless valve implantation.
• This case demonstrates a viable strategy for managing prosthetic valve endocarditis and complex aortic pathology.