Surgical experience with infective endocarditis and aortic root abscess

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Cardiac Surgery

Background:

• Active infective endocarditis with aortic root abscess presents a significant surgical challenge.
• This condition requires complex management involving debridement and valve replacement.

Purpose of the Study:

• To evaluate the surgical outcomes of patients with active infective endocarditis and aortic root abscess.
• To assess operative mortality, postoperative function, and long-term survival.

Main Methods:

• Retrospective analysis of 49 patients undergoing surgery for active endocarditis with aortic root abscess between 1999 and 2012.
• Procedures included wide debridement of abscess and aortic valve replacement, with or without patch reconstruction.
• Involved anatomical sites included the aortic annulus, left ventricular outflow tract, fibrous trigone, and mitral annulus.

Main Results:

• Operative mortality was 12% (6 deaths), primarily due to sepsis and multi-organ failure.
• Postoperative echocardiography showed improved left ventricular dimensions but decreased ejection fraction.
• Long-term follow-up demonstrated no late deaths or recurrent endocarditis, with significant improvement in New York Heart Association functional class (from 3.2 to 1.2).

Conclusions:

• Surgical treatment for active infective endocarditis with aortic root abscess remains challenging with considerable operative risk.
• Despite initial mortality, long-term survival is excellent, with good functional capacity achieved post-recovery.