Yonsei Med J.  2014 Sep;55(5):1253-1259. 10.3349/ymj.2014.55.5.1253.

Surgical Experience with Infective Endocarditis and Aortic Root Abscess

• Lee S
• Chang BC
• Park HK

• KMID: 1799488
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1253

Abstract

PURPOSE
This study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation.
MATERIALS AND METHODS
Between February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50+/-14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed.
RESULTS
There were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8+/-11.8 mm to 52.6+/-8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4+/-12.0% to 49.8+/-16.5%, p<0.001). The mean follow-up duration was 68.7+/-40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2+/-0.7 to 1.2+/-0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%.
CONCLUSION
Surgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.

Keyword

Endocarditis; aortic root; abscess

MeSH Terms

Abscess/*surgery
Adult
Aortic Valve/microbiology/*surgery
Debridement
Endocarditis/*surgery
Female
Follow-Up Studies
Heart Valve Prosthesis/*microbiology
Heart Valve Prosthesis Implantation/*adverse effects/mortality
Humans
Intraoperative Complications/epidemiology
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications/epidemiology
Retrospective Studies

Figure

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  Fig. 1 Overall Kaplan-Meier estimated survival rates at 1, 5, and 10 years were 87.2%, 87.2%, and 87.2%. YSR, year survival rate.

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  Fig. 2 Kaplan-Meier estimated survival rate at 10 year was higher in native valve endocarditis than prosthetic valve endocarditis (92.9% vs. 78.9%, p=0.165) without statistical significance. YSR, year survival rate.

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