Surgical treatment of paraannular aortic abscess

Aortic valve endocarditis with paraannular abscess remains a challenging problem in the surgical treatment of native and prosthetic valve endocarditis. The purpose of this study is to evaluate the long-term outcome of surgical intervention for aortic paraannular abscess.

From January 1989 to November 2004, 32 consecutive patients (24 men, 8 women) were studied. Mean age was 50.6 +/- 16.2 (range, 17-80) years. Twenty-four had native valve endocarditis and 8 had prosthetic valve endocarditis. Eight of 24 patients who suffered from native valve endocarditis had bicuspid valve endocarditis. The predominant microorganism was Streptococcus viridans. No microorganisms were identified in 11 patients. Most patients were desperately ill at the time of surgery. Repair was performed by aggressive eradication of infected tissue and reconstruction of the defect with autologous pericardium (n = 24), bovine pericardium (n = 3), Dacron patch (n = 4), and primary closure (n = 1).

Although postoperative complications were common, early mortality occurred in only 4 patients (12.5%). Operative survivors have been followed for 5 months to 16 years (mean, 92.7 months). There were 2 late deaths but all were noncardiac deaths. Five patients (15.6%) underwent reoperation at a mean of 55.4 months after the initial surgery. The actuarial survival at 1, 5, and 10 years was 87.4% +/- 5.9%, 83.2% +/- 6.9%, and 79.1% +/- 7.7%, respectively. The freedom from reoperation at 1, 5, and 10 years was 88.7% +/- 6.2%, 79.8% +/- 8.1% and 75.4% +/- 8.8%, respectively.

These data suggest that aggressive surgical intervention and meticulous antibiotic therapy for aortic valve endocarditis with paraannular abscess yields a high success rate with relatively low mortality and good long-term results.