Re-operative hemi-commando operation without a homograft: an alternative approach for complex aortic root abscess

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Aortic Surgery

Background:

• Aortic root abscesses and prosthetic valve dehiscence are rare but serious complications.
• Staphylococcus epidermidis bacteraemia can lead to severe cardiac pathology.
• Patients with prior aortic valve replacement and aortic dissection are at higher risk.

Purpose of the Study:

• To describe a complex surgical approach for managing aortic root abscess with prosthetic valve dehiscence and severe mitral regurgitation.
• To highlight the technical aspects of radical debridement and reconstruction in a challenging anatomical context.
• To present a successful outcome following a multi-stage surgical intervention.

Main Methods:

• Radical debridement of the aortic root and aorto-mitral curtain via an extended transseptal approach.
• Mitral valve repair using a partial annuloplasty ring and a double-patch technique.
• Implantation of a handmade composite Bentall graft with coronary button reimplantation and hemiarch replacement.
• Saphenous vein graft to the distal right coronary artery (RCA).

Main Results:

• Successful debridement of the aortic root abscess and repair of the mitral valve.
• Complete reconstruction of the aortic annulus and ascending aorta using a Bentall graft.
• Reimplantation of coronary arteries and hemiarch replacement.
• Postoperative recovery with resolution of bacteraemia and improved cardiac function.

Conclusions:

• Complex aortic root pathology involving abscess and prosthetic dehiscence can be managed with meticulous surgical technique.
• An extended transseptal approach combined with advanced reconstruction methods allows for radical debridement and valve repair/replacement.
• This case demonstrates the feasibility of a comprehensive surgical strategy in high-risk patients with extensive aortic disease.