Abstract
ObjectivesAortic valve endocarditis is occasionally complicated by periannular spreading of the infection and abscess formation, leading to a more aggressive course of the disease and life-threatening complications. This retrospective observational study investigated the long-term outcomes of patients with this complication, which was surgically managed with annular reconstruction and aortic valve replacement.MethodsBetween 1998 and 2018, 69 patients were identified with aortic valve endocarditis complicated by periannular abscess formation. All patients were treated with debridement of the infected tissue, gentamicin filling of abscess cavities, annulus reconstruction with bovine pericardium, and valve replacement. Long-term follow-up was performed to detect the rate of recurrence of endocarditis, aortic valve reoperation and survival.ResultsMean age was 58 ± 15 years, 81% of patients were male, and the infected valve was native in 51% of all patients. The overall mortality was 36%, with a 30-day mortality of 13% and 120–day mortality of 16%. Five- and 10-year survival was 69.4 ± 12.0% and 55.7 ± 14.3%, respectively. Ten-year freedom from recurrent endocarditis was 83.5 ± 13.3%.ConclusionEndocarditis with annular abscess remains associated with high morbidity and mortality and aggressive treatment of the infected tissue and abscess cavities is crucial. Compared with earlier literature, long-term outcome of annular reconstruction in this series is comparable to that of aortic root replacement.
Highlights
Active infective endocarditis is a life-threatening condition that commonly affects the heart valves and requires urgent medical care
We sought to review our database since 1998 to investigate the incidence and long-term outcome of patients with endocarditis complicated by periannular abscess, who are treated with annular reconstruction and aortic valve replacement
Sixty-nine patients (13%) who suffered from infective endocarditis of the aortic valve complicated by aortic periannular abscess formation were identified from the Catharina Hospital Eindhoven cardiac surgery database for a retrospective study
Summary
Active infective endocarditis is a life-threatening condition that commonly affects the heart valves and requires urgent medical care. Despite the high morbidity and mortality of aortic valve endocarditis complicated by periannular abscess formation, reconstruction of the annulus with a gentamycin-pericardial patch and valve replacement is a successful treatment. Surgical treatment and long-term outcome of aortic valve endocarditis with periannular abscess 345. Delay of surgery might lead to further destruction of the aortic root, a higher risk of complications, and a more complex surgical procedure. The primary goal of surgery in these cases is radical debridement of the infected tissue, reconstruction of the excised area, and replacement of the aortic valve or root [7]. We sought to review our database since 1998 to investigate the incidence and long-term outcome of patients with endocarditis complicated by periannular abscess, who are treated with annular reconstruction and aortic valve replacement
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