Absceso paravalvular en la endocarditis bacteriana: influencia en el pronóstico postoperatorio

Abstract

ObjectiveParavalvular abscess (PAb) increases mortality, complexity and complications associated with infectious endocarditis (IE) surgery. We analysed the impact of PAb in different clinical presentations of IE. MethodsRetrospective, observational study that included all patients undergoing heart surgery because of EI between 2002 and 2015 in one center. Clinical follow-up was performed after discharge. Results169 patients were operated, and there was a PAb present in the 33% of them. Abscess was associated with increased perioperative mortality (30.9% vs. 23.4%)) and permanent pacemaker implantation (15.2% vs. 9.3%).PAb was significantly more frequent in aortic (50.0%) than in mitral (20.3%) surgery, as well as in native (44.4%) versus prosthetic (26.2%) IE.The presence of abscess significantly increased surgical mortality in aortic IE (21,4% vs. 3.6%; P=.043), with no significant differences in mitral IE (25,5% vs. 25%; P=.97). It was also associated with higher but no significantly increased mortality in native endocarditis (29.6% vs. 19.7%), with similar results in prosthetic IE (32,1% vs. 31,4%).After a median follow-up of 51 months after discharge, survival (70.6% with PAb vs. 75.7% without PAb) and re-infection (13.3% vs. 10,2%) were similar among patients with and without PAb. ConclusionThe presence of PAb was associated with poor prognosis in IE, especially in aortic and native valve involvement. When indicated, early surgery could be beneficial in these patients to prevent abscess formation. After discharge patients had a similar long-term prognosis.