Introduction
Infective endocarditis (IE) involving the aortic valve is associated
with risk of heart failure, septic embolism and conduction block (1).
About twenty percent of these patients have extension of the infection
into the surrounding aortic root in the form of abscess (1). Root
abscesses occur more commonly in prosthetic valve endocarditis (PVE)
than native valve endocarditis (2). The definitive management of such is
surgical which often carries high risk of mortality, ranging between
14% to 26% (2-4) with some reporting up to 39% mortality for PVE (5).
The principal of surgery for IE is radical debridement of all infected
tissues and replacement of necessary structures. Surgery for aortic root
abscess involves extensive debridement followed by root reconstruction
with pericardial patch plus aortic valve replacement or root
replacement, often by a cryopreserved homograft. Our strategy for aortic
root abscess has been radical resection of infected material, repair of
any fistulae and other cardiac defects with biological material
(autologous or bovine pericardium), and homograft reconstruction of the
aortic root. In this report, we review our institutional experience in
surgical management of infective endocarditis with aortic root abscess
using homograft. We also review whether this technically demanding
operation can be safely passed on to the next generation of cardiac
surgeons (6).