A Case of Aortic Root Reconstruction with Y-Incision for Prosthetic Valve Infection with Perivalvular Abscess

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Prosthetic valve endocarditis complicated by periannular abscess and aortomitral curtain destruction (n=1). Intervention: Redo aortic valve replacement (21-mm Avalus bioprosthesis) with aortic root reconstruction using the Y-incision technique and Hemashield patch. Primary outcome: Postoperative clinical recovery and absence of recurrent infection or heart failure at 6 months.

Q: What does this research mean for the field?

Aortic root reconstruction using the Y-incision technique is a feasible and effective alternative to full root replacement in patients with prosthetic valve endocarditis and localized periannular abscess. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Kyohei Kawasaki; Takuya Miyazaki; Tadashi Isomura

doi:10.4326/jjcvs.55.231

September 15, 2026Japanese Journal of Cardiovascular SurgeryOpen Access

A Case of Aortic Root Reconstruction with Y-Incision for Prosthetic Valve Infection with Perivalvular Abscess

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Key result

Y-incision root reconstruction and redo AVR achieves infection-free recovery at 6 months in endocarditis.

n=1

Why the study?

In a patient with prosthetic valve endocarditis and localized posterior annular abscess after two prior cardiac surgeries, full aortic root replacement requiring dissection of a sclerotic root needed to be avoided.

Does aortic root reconstruction using the Y-incision technique with a Hemashield patch and redo surgical AVR successfully treat prosthetic valve endocarditis complicated by localized periannular abscess and aortomitral curtain destruction in an elderly high-risk patient?

Key Points

To report a case of redo aortic valve replacement combined with aortic root reconstruction using the Y-incision technique for prosthetic valve endocarditis with periannular abscess formation.
An 89-year-old man with Staphylococcus epidermidis prosthetic valve endocarditis, prior coronary artery bypass grafting, and aortomitral curtain destruction underwent radical debridement.
Aortic root reconstruction was performed using a Hemashield patch adapted with a Y-incision approach, followed by implantation of a 21-mm Avalus bioprosthetic valve.
Postoperative blood cultures remained negative, and the patient achieved an uneventful recovery and was discharged on postoperative day 49.
Postoperative transthoracic echocardiography showed a left ventricular ejection fraction of 58.2%, mean aortic valve pressure gradient of 3 mmHg, valve area of 1.6 cm2, and no paravalvular leak.
Computed tomography confirmed disappearance of the pseudoaneurysm without left coronary artery kinking, and no recurrent infection or heart failure occurred during 6 months of follow-up.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does aortic root reconstruction using the Y-incision technique with a Hemashield patch and redo surgical AVR successfully treat prosthetic valve endocarditis complicated by localized periannular abscess and aortomitral curtain destruction in an elderly high-risk patient?

P

Population

1 89-year-old man with prosthetic valve endocarditis, localized periannular abscess, and two prior sternotomies, followed for 6 months postoperatively.

I

Intervention

Preoperative cefazolin sodium 3 g/day, followed by radical debridement, aortic root reconstruction using the Y-incision technique with a 40-mm Hemashield woven graft patch sutured to both fibrous trigones and the mitral annulus, and redo surgical aortic valve replacement with a 21-mm Avalus bioprosthesis, followed by 7 weeks of postoperative intravenous cefazolin sodium 3 g/day and transition to oral minocycline.

O

Outcome

Postoperative recovery, infection control (negative blood cultures), structural integrity of the reconstructed aortic root on computed tomography and echocardiography, and freedom from recurrent infection or heart failure at 6 months follow-up.hard clinical

In selected elderly redo patients with prosthetic valve endocarditis complicated by a localized posterior periannular abscess and controlled infection, aortic root reconstruction using the Y-incision technique with a Hemashield patch and redo AVR may serve as a less invasive and effective alternative to full aortic root replacement.

Limitations

Single patient case report
Technique requires preoperatively controlled infection and localized tissue destruction
Potential risks of Y-incision include lack of left ventricular outflow tract enlargement, left coronary artery kinking or stenosis, and sinus turbulence if the valve plane tilts
Long-term follow-up is needed to monitor for infection recurrence
Left ventricular outflow tract enlargement is not achieved with the Y-incision technique
Potential risk of kinking or stenosis of the left coronary artery with the Y-incision technique
Potential for turbulence in the sinus of Valsalva if the prosthetic valve plane is tilted
Further follow-up is necessary to monitor for relapse of infection

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Implication

May support Y-incision root reconstruction in select high-risk redo endocarditis; leaves open larger series before wider adoption.

Abstract

症例：89歳男性，20年前に狭心症に対して冠動脈バイパス術（Coronary Artery Bypass Graft: CABG），1年前，88歳で重症大動脈弁狭窄症（Aortic valve stenosis: AS）による急性心不全に対して大動脈弁置換術（Aortic valve replacement: AVR）を施行した患者．腰痛を主訴に救急受診し，化膿性脊椎炎の診断となった．血液培養からStaphylococcus epidermidis（S.

Discussion

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Cite This Study

Kawasaki et al. (2026) conducted a case report in Prosthetic valve endocarditis complicated by periannular abscess and aortomitral curtain destruction (n=1). Redo aortic valve replacement (21-mm Avalus bioprosthesis) with aortic root reconstruction using the Y-incision technique and Hemashield patch was evaluated on Postoperative clinical recovery and absence of recurrent infection or heart failure at 6 months. Aortic root reconstruction using the Y-incision technique and redo AVR in an 89-year-old with prosthetic valve endocarditis resulted in discharge at day 49 and no recurrence over 6 months.

synapsesocial.com/papers/6af0e999de503f3774140a4a https://doi.org/10.4326/jjcvs.55.231

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A Case of Aortic Root Reconstruction with Y-Incision for Prosthetic Valve Infection with Perivalvular Abscess

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

A Case of Aortic Root Reconstruction with Y-Incision for Prosthetic Valve Infection with Perivalvular Abscess

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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