Stentless Xenograft Repair of Excavating Aortic Root Sepsis

BACKGROUND: A variety of surgical techniques are used to manage a disintegrated aortic annulus in patients with endocarditis and excavating aortic root sepsis. Homograft root replacement is preferable in this setting but suitable homografts are restricted in availability and excision of the aortic root carries the risk of postoperative bleeding. As an alternative we used a stentless porcine xenograft root (Medtronic Freestyle valve) to manage this problem. METHODS: Three male patients with active endocarditis presented with aortic root abscess and partial or complete aorto-left ventricular discontinuity. One had prosthetic valve endocarditis, and the abscess cavity entered the right atrium in another. The porcine aortic root was successfully implanted using the modified subcoronary technique providing a repair within the aortic root with proximal and distal suture lines that excluded the disintegrating tissues from the blood stream. All patients were treated with intravenous antibiotics for 6 weeks postoperatively and none suffered recurrent infection (follow-up > 6 months). CONCLUSION: The stentless porcine aortic root implanted within the human aorta provides an additional surgical option for excavating aortic root sepsis.