Surgery for Aortic Root Abscess: A 15-Year Experience

Abstract

Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit.

Surgical treatment and long-term outcome of aortic valve endocarditis with periannular abscess

“…The number of mortality events (n = 25) was too small to adjust survival for other variables. These results are in accordance with earlier research findings inferring worse early and late outcomes in PVE as it is frequently associated with periannular abscess, increasing the complexity of surgical treatment [4,5,28].…”

“…The mean five-year and 10-year survival rate in our study are comparable to previous studies suggesting that surgical treatment for infective endocarditis complicated by periannular or paravalvular abscess formation corresponds with a declining survival rate with increasing follow-up time [5,13,28]. Kirali and colleagues presented a five-year and 10-year survival rate of 62.9 ± 6.4% and 59.2 ± 7.2%, respectively [28]. A possible explanation for this slight difference compared to the current series can be their smaller patient population (n = 27) or their inclusion of patients undergoing aortic root replacement.…”

Rupture of Sinus of Valsalva with Endocarditis and Aortic Root Abscess

“…The type & virulence of the microorganism and resistance of the host are important in determining the fate of IE; it's complications like paravalvular abscess, cardiac fistulas and severe destruction of the native aortic valve. A mechanical valve is often infected in its sewing ring and the infection also extends into surrounding structures [9]. The microbiology of the IE also depends on the nature of valve i.e.…”

“…Early and extensive surgical resection of aortic root abscess followed by its reconstruction can be life saving as antibiotics alone are usually ineffective to stop the destruction of cardiac tissue by the abscess [9].…”

“…Aortic root abscess is the most severe sequela of infective endocarditis and its surgical management is a complicated procedure because of the high risk of morbidity and death [9]. SOVA with aortic root abscess has rarely been reported.…”