Successful Management of Aortic Valve Endocarditis with Associated Periannular Abscess and Aneurysm

Aortic valve endocarditis extending beyond the aortic root presents a particularly difficult management problem. During a four-year period we have seen four patients with extensive annular abscesses involving the native valve (in 1 patient) and prosthetic valves (in 3). In all these patients the aortic roots were debrided and valved conduits were replaced with coronary artery grafts while appropriate antibiotics were administered. Postoperative complications included conduction abnormalities, hemorrhage, and low cardiac output, but all 4 patients were discharged from the hospital. Two patients died, 1 of an unrelated disease at 13 months postoperatively and 1 of endocarditis at 16 months postoperatively. The two remaining patients are alive and well at 11 and 46 months postoperatively. We conclude that, in spite of the prosthetic material required, this procedure permits adequate debridement and safe reconstruction for the rare patient in whom endocarditis has resulted in aortic-ventricular discontinuity.