Figure 2.

Illustration of operative repair in a patient with bioprosthetic valve endocarditis with root abscess. Given the extensive infection, a homograft root replacement was performed after aortic-mitral continuity was reestablished with a bovine pericardial patch repair and the anterior leaflet of the mitral valve was resuspended. Direct reimplantation of the coronary arteries was not possible, and with no available saphenous vein conduit and in the setting of extensive infection, the “immobile” coronary arteries were reimplanted using a modified Cabrol extension with homograft femoral artery. A mildly aneurysmal native ascending aorta allowed for a fairly anterior placement of the left coronary artery without kinking or concern for compression between the neoaorta and pulmonary artery.