Infectious Aortic Root Pseudoaneurysm after Bentall Procedure: To Treat or Not to Treat by Redo Operation?

Giovanni Ruvolo,Sara R Vacirca,Fabio Bertoldo,Guglielmo Saitto,Marta Pugliese,Marco Russo,Paolo Nardi

doi:10.1055/s-0039-1694013

Abstract

We present a case of a 75-year-old man who developed an early aortic bioprosthesis endocarditis due to Klebsiella pneumoniae complicated by aortic root pseudoaneurysm after Bentall procedure. A prompt surgical option was hypothesized, but we decided to wait and keep on clinical observation and antibiotic therapy. One year after discharge, we observed stable clinical conditions and echocardiographic findings. A question: to treat or not to treat by redo operation an infectious aortic root pseudoaneurysm?

Highlights

We present a case of a 75-year-old man who developed an early aortic bioprosthesis endocarditis due to Klebsiella pneumoniae complicated by aortic root pseudoaneurysm after Bentall procedure
A 75-year-old man affected by aortic root aneurysm (43 mm, with intraoperative findings of high displacement of coronary ostium, frail and thin aortic wall and an asymmetrical enlargement of the “non coronary sinus”) associated with severe bicuspid aortic valve stenosis underwent electively Bentall procedure with a composite graft constructed using a Trifecta 23 mm bioprosthesis
The composite conduit was implanted using multiple 2/0 nonabsorbable interrupted sutures buttressed with subannular Teflon felts passing once through the bioprosthesis annulus and Dacron conduit

Summary

Introduction

Prosthetic valve endocarditis (PVE) is a complication following heart valve replacement with a reported frequency ranging from 0.3 and 1.2 per patient-year and a lifetime occurrence of 1 to 6% of patients after prosthetic valve replacement.[1]Despite advances in diagnostic options, treatment, and follow-up, the in-hospital mortality rate is still very high and more than one-third of patients die within the first year from the diagnosis.[2,3]Case PresentationA 75-year-old man affected by aortic root aneurysm (43 mm, with intraoperative findings of high displacement of coronary ostium, frail and thin aortic wall and an asymmetrical enlargement of the “non coronary sinus”) associated with severe bicuspid aortic valve stenosis underwent electively Bentall procedure with a composite graft constructed using a Trifecta 23 mm bioprosthesis Keywords ► prosthetic valve endocarditis ► aortic root pseudoaneurysm ► redo operation We present a case of a 75-year-old man who developed an early aortic bioprosthesis endocarditis due to Klebsiella pneumoniae complicated by aortic root pseudoaneurysm after Bentall procedure.

Results

Conclusion