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Surgical treatment of paravalvular abscess: long-term results
Tirone E David1, Tommaso Regesta, Gheorghe Gavra
1Peter Munk Cardiac Centre at University Health Network, University of Toronto, Toronto, Ont., Canada. tirone.david@uhn.on.ca
Objective:
To examine the outcomes of surgery for active infective endocarditis with paravalvular abscess.
Methods:
Paravalvular abscess was defined as infective necrosis of the valve annulus that required patch reconstruction before implanting a new valve. Of 383 patients with active infective endocarditis who underwent surgical treatment, 135 (35%) had paravalvular abscess. Patients' mean age was 51+/-16 years and 68% were men. The infected valve was native in 69 patients and prosthetic in 66. The abscess involved the aortic annulus in 73 patients, the mitral annulus in 27, the aortic and mitral annuluses in 33, and the aortic and tricuspid and/or pulmonary annuluses in 2. Surgery consisted of radical resection of the abscess, reconstruction of the annulus with patches and valve replacement. Mean follow-up was 6.2+/-5.2 years and complete.
Results:
There were 21 (15.5%) operative deaths. Preoperative shock and abscess in the aortic and mitral annuluses were independent predictors of operative death. There were 34 (25%) late deaths. Survival at 15 years was 43+/-6% for all patients, 50+/-8% for native valve endocarditis and 35+/-9% for prosthetic (p=0.41). Age by increments of 5 years and recurrent endocarditis were independent predictors of late death. There were 16 episodes of recurrent endocarditis in 15 patients, and the freedom from recurrent endocarditis was 82+/-4% at 15 years. Fifteen reoperations were performed in 14 patients. Freedom from reoperation was 72+/-9% at 15 years.
Conclusions:
Surgery for active endocarditis with paravalvular abscess was associated with high operative mortality, particularly in patients in shock and abscess of both mitral and aortic annuluses. Long-term survival was adversely affected by age and recurrent bouts of endocarditis.
Insights
Surgery for infective endocarditis with paravalvular abscess has high operative mortality, especially in patients with shock or combined aortic and mitral abscesses. Long-term survival is impacted by patient age and recurrent endocarditis.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Cardiac Surgery Outcomes
Background:
- Paravalvular abscess is a severe complication of active infective endocarditis.
- Surgical intervention is often necessary but carries significant risks.
- Understanding outcomes is crucial for patient management and surgical planning.
Purpose of the Study:
- To evaluate the surgical outcomes for patients with active infective endocarditis and paravalvular abscess.
- To identify predictors of operative mortality and long-term survival.
- To assess the rates of recurrent endocarditis and reoperation.
Main Methods:
- Retrospective analysis of 383 patients with active infective endocarditis.
- 135 patients (35%) had paravalvular abscess requiring patch reconstruction and valve replacement.
- Mean follow-up of 6.2 years.
Main Results:
- Operative mortality was 15.5%, with shock and combined aortic-mitral abscesses as predictors.
- 15-year survival was 43%, lower for prosthetic valve endocarditis.
- Predictors of late death included age and recurrent endocarditis; 15-year freedom from reoperation was 72%.
Conclusions:
- Surgery for infective endocarditis with paravalvular abscess is associated with high operative mortality.
- Patient age and recurrent endocarditis significantly affect long-term survival.
- Careful patient selection and management are essential.
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