Outcome of surgical intervention for aortic root abscess: a meta-analysis

Chen, Guan‐Jhou; Lo, Wei Cheng; Tseng, Hsien Wei; Pan, Sung‐Ching; Chen, Yih‐Sharng; Chang, Shan-Chwen

doi:10.1093/ejcts/ezx421

Cited by 24 publications

(38 citation statements)

References 27 publications

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“…No impact on hospital mortality was found according to the interval time between admission and surgery. With all the limitations of our numbers, our experience supports previous reports about aortic root abscess surgery (2,4,6,14,16) and follows the most recent guidelines (17,18). Both European Society of Cardiology (ESC) and American Heart Association (AHA)/American College of Cardiology (ACC) papers, despite a different definition of the timing categories, provide IB recommendation for early surgery (within a few days) in these kind of cases of complicated native and prosthetic valve endocarditis presenting with tissue disruption, false aneurysm and heart failure symptoms.…”

Section: Discussionsupporting

confidence: 88%

“…Aortic valve endocarditis remains a life-threatening condition that is still burdened by significant mortality and morbidity rates. Involvement of the surrounding tissue has been described in about 20% of cases (1) and is more frequent in cases of Staphylococcus aureus infection and in prosthetic valve endocarditis (2). The local extension of the infective process causes tissue destruction and periannular abscess formation.…”

Section: Introductionmentioning

confidence: 99%

“…The progression of the pathology may further complicate the scenario, with fistulisation in other cardiac structures or the development of a pseudoaneurysm (3). Surgical therapy is invariably required in these cases and represents the only therapeutic option, but it is associated with high postoperative mortality and morbidity (2,4,5). In this paper, we describe our experience in the treatment of aortic valve/aortic root endocarditis complicated by extensive annular and periannular tissue disruption.…”

Section: Introductionmentioning

confidence: 99%

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Aortic valve endocarditis complicated by proximal false aneurysm

Malvindi

Mikus

Caprili³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Aortic valve endocarditis remains a life-threatening condition, especially in cases of periannular complications. Aorto-ventricular discontinuity associated with proximal false aneurysm represents a severe picture caused by extensive tissue disruption and is usually associated with prosthetic valve infection. Complex surgical repair is required in these cases and continues to be associated with high mortality and morbidity rates.Methods: We retrieved information for 32 patients undergoing operation for infective aortic valve/ prosthetic valve endocarditis complicated by pseudoaneurysm arising from aorto-ventricular discontinuity.Patients were relatively young, mostly male and most of them had a prior cardiac operation. Aortic root replacement with valve graft conduit was performed in all cases; it was associated with other procedures in seven patients: CABG (n=2), MV surgery (n=3), MV surgery + CABG (n=1) and pulmonary valve replacement (n=1). We reported and analysed patient outcomes at early and mid-term follow-up.Results: Pre-discharge mortality was 22% (n=7). The postoperative course was complicated in 24 (75%) cases. Eighteen patients (56%) sustained low cardiac output resulting in multiple organ failure syndrome and death in five cases. One patient (3%) experienced a major neurologic deficit with a permanent cerebral stroke. Acute kidney injury complicated the course in 12 cases (37%), continuous renal replacement therapy was necessary in four patients (12%). Overall survival and freedom from endocarditis and reoperation at 5-year was 59% and 89%, respectively. Conclusions:Patients with complicated aortic valve endocarditis presented generally in a poor preoperative state. Surgical treatment poses a non-negligible risk of postoperative mortality and morbidity but provides an acceptable survival rate and a satisfactory recovery at mid-term.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aortic valve endocarditis complicated by proximal false aneurysm

Malvindi

Mikus

Caprili³

et al. 2019

Ann. Cardiothorac. Surg.

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“…An aortic root abscess is an exceedingly destructive form of infective endocarditis that can manifest as various types of pathology, including fistula, pseudoaneurysm, coronary obstruction, or arrhythmia. 8 , 9 As the opioid epidemic has continued to spiral, intravenous drug use undoubtedly plays a role in the incidence and severity of such disease. All cases in this series involved recidivant drug use, with subsequent infection recurrence leading to aortic root infections.…”

Section: Discussionmentioning

confidence: 99%

“… 8 After extensive debridement, aortic root reconstruction is performed by patching the remaining tissue and placing an aortic valve prosthesis. 9 Unfortunately, a rising incidence of cardiovascular infections has been directly linked to the current opioid epidemic. 10 As the opioid epidemic continues, there is utility in pursuing multidisciplinary care of affected patients.…”

Section: Introductionmentioning

confidence: 99%

Cardioplastic Approach to Omental Flap Coverage for Severe Aortic Root Infections in the Opioid Era

Bonaroti

Edmunds

DeCoster

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Aortic root abscesses are severe sequelae of endocarditis that clinically manifest as life-threatening infection. As the opioid epidemic continues to yield a national crisis, the incidence and severity of this disease process have increased. Reconstruction of the aortic root is a challenging undertaking and carries the risk of recurrent infection. The omentum has an established reputation as a reliable flap in thoracic reconstruction, given its amorphous form and immunogenic properties, but it has not been utilized for aortic root infections. We present a novel indication for the omental flap using a cardioplastic approach in coverage of aortic root reconstruction. Four patients were treated with pedicled omental flap coverage after aortic root reconstruction. All patients had successful flap healing with no evidence of recurrent infection. This series demonstrates the technical feasibility and clinical utility for providing soft tissue coverage and antimicrobial protection when used in aortic root reconstruction.

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