Abstract
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 Staphylococcus xylosus 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.