Infective endocarditis after Bentall operation is rare and its diagnosis may be difficult.

We described clinical presentation, management, outcomes and the use of new imaging added in the 2015 European Society of Cardiology guidelines (¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography, radiolabelled white blood cell single-photon emission computed tomography/computed tomography and Cardiac computed tomography) in patient with infective endocarditis after Bentall.

We retrospectively identified all patients with definite infective endocarditis after Bentall hospitalized in a tertiary care centre in Paris, France between 2005 and 2016.

Twenty patients were identified (Median age 61 years, 95% male). Most cases occurred more than twelve months after the Bentall procedure (65%). Ten patients had complications (mainly stroke). The most common pathogen was Staphylococcus aureus (45%). Lesions using echocardiography were observed at the aortic valve and/or tube level in 18 patients. The most frequent lesion was a peri-prosthetic abscess and peritubular thickening/collection. At least one new imaging testing was performed in 12 patients (60%). The diagnosis of definite infective endocarditis relied on the modified Duke criteria in 17 patients and on new imaging in 3 patients. Disagreement between the different new imaging tests was relatively common. Eighteen patients (90%) underwent surgery and 4 died during their hospital stay (20%).

Infective endocarditis after Bentall mainly occurred late after surgery and was due to S. aureus. New imaging was a useful adjunct in patients with non-definite infective endocarditis and should be integrated into clinical judgment. Mortality was high and surgery was a cornerstone of the management.