Comparison of long term outcome in patients with or without aortic ring abscess treated surgically for aortic valve infective endocarditis

Abstract

Objective-To assess the long term prognostic significance of aortic valve ring abscess in patients with aortic endocarditis. Patients-A consecutive series of 75 patients who had surgery for aortic infective endocarditis between 1981 and 1989; 35 had aortic ring abscesses (group 1) and 40 did not (group 2). Mean age did not diVer between the two groups. Prosthetic valve endocarditis was present in 17% of group 1 and 5% of group 2. Pneumococcal or haemolytic streptococcal endocarditis was more common in patients with native valve endocarditis who had aortic ring abscesses (20% v 5%). Design-Cohort analysis. Results-In-hospital mortality (11.4% v 7.5%) and 10 year survival (56% v 66%) were not significantly diVerent between groups 1 and 2. In patients with native valve endocarditis, 10 year survival was 62% and 66%, respectively for patients with or without ring abscess, and 10 year reintervention-free survival was 38% v 58% (p = 0.11). In these patients, the presence of an intercurrent illness, severe congestive heart failure before surgery, and use of valved conduits for surgical treatment were predictors of poorer long term survival. At follow up residual aortic regurgitation was documented in 72% of patients in group 1 and 26% in group 2 (p < 0.01). Conclusions-Aortic valve ring abscess is not an independent marker of poor long term outcome in patients with infective endocarditis. However, as residual aortic regurgitation appears frequent at follow up, specific surgical techniques should be considered in patients with paravalvar abscesses.

Infective endocarditis: surgical therapy

“…Despite the extensive débridement and closure of the cavities and fistulas by using autologous or bovine pericardium, 5 patients required more than 1 surgical intervention due to a relapse of the endocarditis or its sequelae. Danchin et al 33 and Renzulli et al 34 did not find differences between the patients with and without perivalvular involvement, and, in a 10-year follow-up, reported a 58% rate of no relapse.…”

Factors Influencing the Results of Double-Valve Surgery in Patients with Fulminant Endocarditis: The Importance of Valve Selection

“…Reinfection is the dominant postoperative complication [David 1996, Danchin 1999 leading to a high mortality rate. An adequate valve substitute [Kirklin 1988, Dearani 1997, Knosalla 2000, Carrel 2003] seems to be the key to breaking this vicious cycle, as we have documented in studies of patients with surgically treated aortic root abscess [Blumberg 1995].…”

Late Endocarditis on Aortic Prosthesis Complicated by an Infectious Aneurysm of the Right Sinus Ruptured in the Right Atrium: A Case Report

“…From a microbiological point of view, in most series, staphylococcus and streptococcus are the two most frequently encountered pathogens with no statistically significant difference [2][3][4][5]. It is a serious condition with a two-month mortality rate close to 15 to 20% in the most recent surgical series [2,3].…”