Modified bentall surgery using a graft insertion technique for prosthetic valve endocarditis with left ventricular–aortic discontinuity: a case report

BACKGROUND: Infective prosthetic valve endocarditis is a life-threatening condition with high morbidity and mortality; it is often complicated by periannular abscesses and left ventricular–aortic (LV–Ao) discontinuity. These situations make standard valve or root replacement technically challenging and require complex reconstructive procedures. CASE PRESENTATION: We report a 59-year-old man with a history of hemiarch replacement and aortic valve replacement for acute Stanford type A dissection. He presented with fever and heart failure symptoms. Imaging revealed severe prosthetic valve regurgitation, periannular abscess, pseudoaneurysm, and LV–Ao discontinuity. Urgent surgery was performed. After complete debridement, the LV outflow tract was reconstructed using the graft insertion technique (GIT) with a Gelweave Valsalva graft and composite graft replacement. The coronary arteries were reconstructed with short interposition grafts. Postoperatively, antibiotics were continued; a permanent pacemaker was implanted for complete atrioventricular block; and the patient was discharged on postoperative day 54. At 1-year follow-up, he remained free of recurrent infection. CONCLUSIONS: The GIT facilitates secure fixation, reliable hemostasis, and reproducible reconstruction even in fragile, infected tissue. Although potential risks, including conduction disturbance and graft infection remain, the method is technically straightforward and can be applied during emergencies. In the case presented here, this approach resulted in satisfactory early outcomes, highlighting the applicability of graft insertion for managing LV–Ao discontinuity in a patient with prosthetic valve endocarditis, particularly when preparation time and graft availability are limited.