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Review
. 2024 May;40(Suppl 1):83-92.
doi: 10.1007/s12055-023-01604-6. Epub 2023 Oct 19.

Contemporary surgical management of infective endocarditis of the aortic root

Muhanad S Algadheeb  1   2 , Mohsyn I Malik  1 , Santiago Besa-Bandeira  1 , Matthew Valdis  1 , Niko Tzemos  3 , Rodrigo Bagur  3 , Michael W A Chu  1
Affiliations
Review

Contemporary surgical management of infective endocarditis of the aortic root

Muhanad S Algadheeb et al. Indian J Thorac Cardiovasc Surg. 2024 May.

Abstract

Infective endocarditis involving the aortic root is associated with a high degree of morbidity and mortality. Native aortic root infections can develop from aggressive organisms or from delays in diagnosis or definitive care, whereas prosthetic valve infections commonly result in extensive destruction of the aortic root and neighboring structures. Early detection, tailored antibiotic therapy, thoughtful pre-operative planning, and multidisciplinary heart team management are the keys to optimizing patient outcomes. Aggressive and complete surgical debridement are mandatory prior to aortic root reconstruction. Surgical experience and patient-centered decision making are critical in selecting the optimal reconstructive strategy for the aortic root and adjacent structures.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-023-01604-6.

Keywords: Aortic root endocarditis; Infective endocarditis; Recurrent prosthetic valve endocarditis.

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Conflict of interest statement

Conflicts of interestMWC has received Speakers’ honoraria from Medtronic, Edwards Lifesciences, Terumo Aortic and Artivion. The other authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Transthoracic echocardiographic images of an infective aortic root abscess with fistulisation into the right atrium. (A) 3-D reconstruction demonstrating the aortic valve vegetation herniating into the right atrium cavity. (B) Parasternal short-axis view of the aortic root and right atrium. The abscess is identified by the white arrow. The red arrow identifies the aortic valve vegetation within the right atrium
Fig. 2
Fig. 2
Computed tomographic coronal slices of the left ventricular outflow tract, aortic root, ascending aorta and right atrium during venous-phase contrast injection. The abscess is identified by the white arrow and the red arrow identifies the aortic valve vegetation within the right atrium
Fig. 3
Fig. 3
Destructive complications of aggressive aortic valve and root infective endocarditis. (A) Perforation of all 3 aortic valve leaflets secondary to infectious endocarditis. (B) Aortic valve endocarditis with perivalvular invasion into the aorto-mitral continuity and right atrial roof
Fig. 4
Fig. 4
Homograft reconstruction of the aortic valve and root. (A) A cryopreserved homograft. (B-C) Proximal anastomosis of the homograft to the left ventricular outflow tract. (D) Completed reconstruction of the aortic root and valve
Fig. 5
Fig. 5
Bentall procedure. (A) Proximal anastomosis of the prosthetic valve and synthetic tubular graft to the aortic annulus. (B) Completed Bentall procedure with re-anastomosed coronary buttons, with concomitant hemiarch reconstruction.
Fig. 6
Fig. 6
Ross procedure. (A) After harvesting of the pulmonary autograft, the proximal anastomosis is performed with proline sutures to the left ventricular outflow tract. (B) The right ventricular outflow tract is reconstructed using a homograft. (C) Distal aortic anastomosis of the pulmonary autograft to ascending aorta. (D) Completion of the Ross procedure
See this image and copyright information in PMC

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