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

Abstract

Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is associated with morbidity and death. We retrospectively report our experience with a valve-sparing technique for managing this condition. From October 2014 through November 2017, 41 patients at our center underwent surgery for aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve. Twenty (48.7%) met prespecified criteria for use of our valve-sparing technique after careful assessment of the mechanical valve and surrounding tissues. Our technique involved draining the abscess, aggressively débriding all infected and necrotic tissues, and then repairing the resulting defect by suturing a Gelweave patch to the healthy aortic wall and to the cuff of the valve. We successfully preserved the mechanical aortic valve in all 20 patients. Two (10%) died early (≤30 d postoperatively) of low cardiac output syndrome with progressive heart failure, superadded septicemia, and multisystem organ failure. At 1-year follow-up, the 18 surviving patients (90%) were symptom free and had a well-functioning mechanical aortic valve with no paravalvular leak. We conclude that, in certain patients, our technique for managing aortic root abscess and sparing the mechanical aortic valve is a safe and less time-consuming approach with relatively low mortality and encouraging midterm follow-up outcomes.

Aortic root abscess from Enterococcus faecalis infective endocarditis: Case report and brief review of the literature

“…The most common interventions include complete resection/reconstruction of the aortic root abscess through graft placement with a new mechanical valve [1 , 14] . Alternatively, in patients where the mechanical valve is still functional, it is possible to perform a valve-sparing technique that only involves resection or reconstruction of the aortic root [15] . While postsurgical complications should always be considered, the risk of recurrent infective endocarditis, as well as complications to the distal aorta, should be monitored [16] .…”