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).