Prosthetic AV endocarditis is a difficult pathology to deal with. In the past my first strategy would be to automatically use an AV homograft. There are specific cases in which a patch can be placed in the healed abcess cavity and a bioprosthetic valve can be implanted.
I have enclosed pictures demonstrating a case in which I performed a minimally invasive AVR 4 years ago and the patient returned with AV endocarditis with a large annular abcess that encircled the left and non coronary infra-annular regions. He was previously treated with IV antibiotics several times and now returned with severe paravalvular AI. I performed a redo minimally invasive (right anterior thoracotomy), removed the old valve, debrided the annulus, placed a large pericardial patch to cover a very large defect and then implanted a new valve. The valve sutures are placed through the patch and into the newly created annulus, which will be the superior aspect of the patch which incorporates aorta.