Redo Aortic Valve Replacement and Ascending Aortic Replacement With LVOT Enlargement Due to Endocarditis

This case involved a 59-year-old woman who had previously undergone aortic valve replacement (AVR) and ascending aortic replacement and developed Staphylococcus epidermidis endocarditis. 

The operation began by commencing venous drainage of the patient, followed by application of the cross-clamp before starting aortic perfusion to stop any debris from dislodging to the brain. 

Upon opening the aorta, pus was immediately seen outside the ascending aortic graft, necessitating complete removal of the graft. 

Attention was paid to avoiding the pulmonary artery, and the presence of pus made it easier to remove the Dacron graft.

The 21 mm biological valve was removed using a scalpel, although previous Cor-Knots made this more difficult. 

After valve removal, further debris was found in the annulus.  During debridement of the annulus, a hole was created in the membranous septum that required later repair. 

The greater curve was excised down to the aortomitral continuity, and a Dacron patch was used to enlarge the annulus and cover the defect.  The valve sutures were then placed, and the new valve was parachuted into place. The aorta was closed using the remaining flame-shaped Dacron graft patch.  

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