Redo Modified Bentall Procedure for Recurrent MRSA Complex Prosthetic Aortic Root Endocarditis Managed Successfully...

Prosthetic valve endocarditis (PVE) remains one of the most challenging complications in cardiac surgery, particularly when caused by methicillin-resistant Staphylococcus aureus (MRSA). It carries high mortality and often mandates complex reoperative procedures. A multidisciplinary approach integrating surgical and antimicrobial strategies is crucial for favorable outcomes.

We report a 52-year-old man with a history of Stanford type A aortic dissection treated in 2013 with aortic root replacement using a 25 mm aortic valve and graft conduit and single-vessel coronary artery bypass grafting (CABG). Twelve years later, he presented with persistent fever and was diagnosed with MRSA prosthetic valve endocarditis unsuccessfully managed medically. Investigations revealed MRSA bacteremia, vegetations on the prosthetic conduit, and periaortic graft thickening. He underwent a high-risk redo Modified Bentall procedure with complete graft and valve explantation, radical debridement, and implantation of a 23 mm mechanical composite valve and graft conduit with saphenous vein reconstruction of the right coronary artery. Postoperatively, he developed complete heart block requiring permanent pacemaker implantation but recovered well on targeted antibiotics.

This case illustrates the complexity of managing recurrent MRSA prosthetic valve endocarditis involving an aortic root graft and highlights that early multidisciplinary evaluation, aggressive surgical debridement, and appropriate antibiotic therapy remain the cornerstone of successful management. The use of a mechanical conduit provided a durable solution in a resource-limited setting without evidence of reinfection.