A Salvage Procedure in a High-risk Case of Prosthetic Valve Endocarditis with Aortic Root Abscess and Valve Dehiscence: A Case Report

REPORTbiventricular failure and extension of aortic root abscess into the base of the anterior mitral leaflet and the aorta.There was a severe paravalvular leak and vegetation on the tricuspid leaflet.After a detailed discussion with relatives about a high risk of mortality and morbidity, he was taken for an emergency salvage procedure at high risk as his Euro score II was 69% (Euro score: 18, logistic: 75.78%).Intraoperative TEE supported the preoperative findings (Figs 1 and2).A homograft aortic valve root replacement with IntroductIonInfective endocarditis (IE) has a 15-30% in-hospital mortality, with the incidence ranging from 3 to 10 cases/100,000 people per year.The multidisciplinary "endocarditis team," including cardiologists, cardiac surgeons, anesthesiologists/intensivists, and specialists in infectious diseases, is invaluable in the treatment of these high-risk patients. 1 The cornerstone for diagnosis is echocardiography and blood culture.The main indications of surgery in prosthetic valve endocarditis (PVE) are heart failure, prevention of embolization, and severe infection, especially in left-sided disease. 1 case descrIptIonA 70-year-old gentleman (body surface area: 1.73 m 2 ) was admitted to the ward for a redo aortic valve surgery for PVE.He had undergone aortic valve replacement (AVR) with coronary artery bypass grafting 5 months ago for aortic regurgitation but remained unwell and was investigated for IE.He was an ex-smoker with a medical history of type 2 diabetes mellitus and renal calculi.The blood cultures were negative, so he was managed conservatively.While waiting for surgery, he developed a sudden onset of breathlessness and hemodynamic deterioration.Hypoxia and severe hypotension were treated with fluid boluses, airway intubation, ventilation, and high doses of vasoconstrictors/inotropes after transferring him to the intensive care unit for an emergency salvage procedure.Bedside transesophageal echocardiography (TEE) revealed severe 1,