Redo Root and RVOT Reconstruction for Destructive Citrobacter Koseri Endocarditis.

BACKGROUND: Citrobacter koseri is a rare cause of adult infective endocarditis and may produce destructive periannular infection. CASE SUMMARY: A 58-year-old hemodialysis patient with prior coronary artery bypass grafting, persistent C koseri bacteremia, and recent drug-eluting coronary stents developed a left ventricular outflow tract-right ventricular outflow tract fistula with aortic root abscess. After cangrelor bridging, he underwent redo sternotomy with bovine pericardial patch repair, Freestyle aortic root replacement, and pulmonary homograft right ventricular outflow tract reconstruction. Six months after discharge, echocardiography showed a normally functioning aortic bioprosthesis and a nonstenotic pulmonary homograft with mild regurgitation. DISCUSSION: This case highlights multidisciplinary management of destructive gram-negative endocarditis requiring complex redo reconstruction and individualized perioperative antiplatelet planning. TAKE-HOME MESSAGE: Complex endocarditis with an aortocavitary fistula may require coordinated antiplatelet management, source control, and multicomponent reconstruction.