Allograft aortic root replacement in complex prosthetic valve endocarditis

Infective endocarditis (IE) is a rare disease but having significant impact on morbidity and mortality [1—3]. When it comes to prosthetic heart valves, a well-known complication after replacement therapy of heart valve disease, the problem becomes even more serious as antibiotic treatment does not fix the problem, requiring a compulsory association with early and radical surgery. In the case of the aortic position, prosthetic valve endocarditis (PVE) usually represents a complex problem due to the commonly associated extension of the disease beyond the aortic annulus to the surrounding structures with invasion of the fibrous body of the heart and eventually leading to abscess formation, and, in the most advanced disease, to aortocavitary fistulae [4,5]. Aggressive forms of PVE, as stated, do still represent a surgical challenge due to the extensive destruction of perivalvular structures. Then, in addition to the regular problems seen in IE, namely sepsis, congestive heart failure or embolic phenomena, PVE of the aortic root often renders the surgeon facing an additional problem, which is the destructionoftheregularanatomy.Theimpactofanatomical