Delayed Open Chest Closure in Prosthetic Aortic Root Endocarditis: A Case Report

Surgical therapy for aortic valve endocarditis can be complicated by paravalvular abscess formation, which is associated with high morbidity and mortality. We report a case of complicated infective endocarditis treated using a delayed sternalclosure (DSC) strategy. DSC after cardiac surgery may be an effective option in managing complicated aortic root endocarditis. On admission, a 60-year-old male presented with symptoms of heart failure and a high-grade fever of unknown origin. He had previously undergone aortic valve reimplantation (David procedure) 10 years earlier for aortic regurgitation and root dilation. Transesophageal echocardiography and contrast-enhanced computed tomography confirmed a para-aortic infiltrate and vegetation on the free margin of the right coronary cusp. The patient underwent explantation of the infected Valsalva prosthesis with thorough debridement of the surrounding infected native aortic root tissues. Due to the extensive spread of infection, DSC with mediastinal drainage was performed. Mediastinal re-exploration and irrigation with Betadine solution were conducted for meticulous washing of all infected areas. The patient’s postoperative course was uneventful, with preserved valve function and no recurrence of abscess at 3-year follow-up. DSC can be considered a therapeutic option in advanced cases of infective endocarditis.