The surgical management of extravalvular aortic root infection

Fifteen patients with extravalvular aortic root infection and associated infective endocarditis underwent urgent operation for this condition at Glasgow Royal Infirmary between 1977 and 1983. Four patients (26.7%) subsequently died between 1 and 68 months after operation. All patients underwent aortic valve replacement, with debridement or suture closure of abscess cavities as indicated. Three patients also required insertion of permanent pacing systems for complete heart block. Three other patients required further surgical intervention. Aortic valve rereplacement was done on two occasions in 1 patient and repair of a periprosthetic leak in the second patient; the third required one additional procedure to close an aorto-right atrial fistula postoperatively. Ten out of 11 survivors are in New York Heart Association Class I, and the remaining patient is in Class II. Aggressive surgical therapy without the need for complicated reconstructive procedures of the aortic root is effective in the management of extravalvular aortic root infections.