Monobloc aorto-mitral homograft as a treatment of complex cases of endocarditis.

This patient was 42 years old when he had a mandible fracture treated with an intermaxillary blockage. The patient presented with endocarditis caused by Kingella denitrificans. There was a large disinsertion of both prostheses, a paravalvular abscess, and a fistula between the aorta and the right atrium. A double valvular replacement redux associated with a closure of the communication was performed. One month later, the abscess had increased, and the 2 prostheses were disinserted again (Fig 1). The hemodynamic results were unstable, and the patient was operated on for the fourth time. This reintervention (Fig 2) was done through a superior transseptal approach.2 The 2 prostheses and all the fibrous mitro-aortic tissue, including both trigones, were removed. This huge resection, enlarged to the roof of the left atrium and to the first 3 cm of the aortic root, allowed a complete resection of the paravalvular abscess. It left a large opening on the right and left atria, the left ventricle, and the aortic root. The 2 coronary ostia were preserved in the button, and their first 2 cm were mobilized. A cryopreserved monobloc aorto-mitral homograft was prepared with a Carpentier Physio The treatment of complex valvular endocarditis remains a surgical challenge (ie, when facing a redo operation,1 double valvular disease, or large abscess caused by aggressive bacteria). In such a situation, we propose a technique that allows a large resection of all the septic tissue and a repair by means of a cryopreserved monobloc aorto-mitral homograft. Clinical summary. A 16-year-old boy was operated on for resection of a subvalvular aortic stenosis. Two months later, postoperative endocarditis caused by Staphylococus aureus necessitated a reoperation. A mechanical bivalvular replacement was performed, and the follow-up was uneventful. MONOBLOC AORTO-MITRAL HOMOGRAFT AS A TREATMENT OF COMPLEX CASES OF ENDOCARDITIS