Double Autologous Pericardial Patch Reconstruction of Two-cusp Aortic Valve Endocarditis With Annular Abscess

Complex aortic valve infectious endocarditis in young people who inject drugs presents unique challenges, and the optimal method of aortic valve reconstruction remains controversial. We present a case of a 33-year-old man with active injection drug use with cardiogenic shock and severe aortic insufficiency secondary to acute <i>Staphylococcus xylosus</i> endocarditis. We performed double autologous pericardial patch reconstruction of 2-cusp aortic valve endocarditis with annular abscess. This case highlights that aortic valve repair with autologous pericardium may offer a durable solution without need for anticoagulation and low risk of reinfection in this challenging population.