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

Aitaliyev S. Karčiauskas D. Mamedov A. Rumbinaitė E. Orazymbetov Y. Jakuška P. Benetis R.
2025 National Scientific Medical Center

Journal of Clinical Medicine of Kazakhstan
2025 #22 Issue 4 89 - 92 pp.

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.

abscess , aortic root , delayed closure , heart valve prosthesis , infective endocarditis , sternum

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Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences, Kaunas Clinics, Lithuanian University of Health Sciences, Kaunas, Lithuania
Faculty of Medicine and Health Care, Al-Farabi Kazakh National University, Almaty, Kazakhstan
Department of Cardiology, of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
Cardiac Surgery Department, National Scientific Medical Center, Astana, Kazakhstan

Department of Cardiac
Faculty of Medicine and Health Care
Department of Cardiology
Cardiac Surgery Department

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