Background The Infection of aortic valve graft conduit is still burdened by notable morbidity and mortality. Medical and surgical strategies play a crucial role in patient outcome and vary depending on infection extend into adjacent cardiac structures, systemic spread and micro-organism involved. Methods In this retrospective study, we report our experience in the management of thirty consecutive patients admitted to our centre with composite aortic valve graft infection during the period 2008-2018. We review the early and mid-term outcomes of patients who underwent a reoperation or received a conservative medical treatment. Results Twenty patients underwent redo surgery with an early mortality of 10% and a survival of 83% at 7-year follow-up. Ten patients were treated medically and experienced an early mortality of 30% and a mid-term survival of 33%. Conclusion A surgical reoperation, despite a non-negligible perioperative risk, is the only radical treatment able to provide a good survival also in patients with complicated infective endocarditis.