Redo Aortic Root Replacement for Infective Endocarditis After Prior Root Surgery: A Case Series and Discussion of Conduit Selection

Background: Redo surgery of the aortic root in the context of prosthetic valve endocarditis (PVE) is among the most technically demanding procedures in cardiac surgery. This case series presents six male patients who underwent redo aortic root replacement following prior root interventions, focusing on surgical strategy, microbiological findings, complications, and outcomes. Cases: A total of 100 patients were treated surgically for aortic valve endocarditis between 2015 and 2025; 38 underwent aortic root procedures. Six patients required redo root replacements and were included in this study. Patient data were extracted from hospital and national databases, and detailed clinical analyses were performed. Five patients underwent homograft implantation, while one patient received a bovine biological conduit. For one patient, this follow-up procedure marked the third cardiac surgery overall and the second intervention on the aortic root. Conclusions: All patients were male with a median age of 61 years [Interquartile range (IQR) 11.5], a median ICU (intensive care unit) stay of 3 days [IQR 1.25], and a total hospital stay of 17 days [IQR 11.5]. No in-hospital mortality or perioperative stroke was noted. Identified pathogens included Streptococcus spp., Granulicatella adiacens, Enterococcus faecalis, and Pseudomonas spp. (PCR only). The cultures remained negative in one case. All patients received six weeks of intravenous antibiotics. Redo root surgery in the setting of PVE poses high operative risks, including technical complexity and reinfection. Surgical success depended on meticulous debridement, individualized conduit selection, and appropriate preoperative planning. Homografts were favored in extensive infections due to the associated resistance to reinfection. This case series demonstrates the feasibility and safety of redoing aortic root replacement for PVE, assuming appropriate surgical and postoperative strategies are implemented, with favorable outcomes, even in high-risk patients.