Tricuspid Aortic Valve Reconstruction with Autologous Pericardium (Ozaki Technique) in Bicuspid Aortic Valve Infective Endocarditis

Currently, the ideal treatment for young IE patients is a topic still debated. The American Association for Thoracic Surgery guidelines advise homograft implantation in cases like this described (Class IIa, level of evidence B). Nevertheless, we did not implant a homograft due to unviability. Therefore, we had to decide between prosthetic valve replacement or AVNeo. In the present case, young age of the patient and specific contraindication to chronic oral anticoagulation due to social issues were considered contraindication to AV replacement with either a biological or a mechanical prosthesis. Furthermore, the durability of most of biological valves in young patients is comparable to the mid-term result of Ozaki follow-up. At the end, we were also worried about the possible risk of reinfection due to the large PA and the presence of a biological prosthesis’ sewing cuff, which might render a reoperation particularly challenging. AVNeo surgery appeared particularly appealing in our patient since any prosthetic material was avoided. In fact, autologous pericardium may be less prone to infection, may make antibiotic treatment more effective, preserve the hemodynamic of the aortic root, and, hopefully, will provide an adequate durability.