Infective endocarditis with aortic root abscess and septic coronary occlusion: Aortic allograft implantation and DOR ventriculoplasty in a redo-operation

Our goal is to present how we handled a complex case of prosthetic aortic valve endocarditis that resulted in severe complications, including an aortic root abscess, complete heart block and coronary artery embolic occlusion leading to myocardial infarction and a left ventricular aneurysm. The patient needed multi-component surgery to treat the infection and address the ventricular issues. Our approach involved exposing the right axillary artery, performing a redo sternotomy, lysing pericardial adhesions and then establishing axillary and bicaval cannulation. Myocardial protection was achieved through both antegrade and direct retrograde cardioplegia. The previous aortic valve and ascending aorta graft were removed, the coronary buttons were created and mobilized, and the aortic root abscess was debrided. The distal aortic stump was fragile and short, necessitating hemi-arch aortic replacement under brief hypothermic circulatory arrest. The left ventricular apical aneurysm was opened, clots removed and a Dor procedure was performed using a Dacron patch. The aortic root was replaced with an aortic allograft. Three epicardial leads were placed and connected to a biventricular pacemaker for resynchronization therapy. The procedure concluded without complications, and the chest was closed.