Surgical Techniques and Outcomes in Patients With Intra-Cardiac Abscesses Complicating Infective Endocarditis

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Intra-cardiac abscess is a severe complication of native and prosthetic valve infective endocarditis.
• Surgical management is indicated, but optimal timing and approach remain debated.
• This study reports outcomes of patients managed for intra-cardiac abscesses over a decade.

Purpose of the Study:

• To evaluate the outcomes of patients managed for intra-cardiac abscesses.
• To compare survival and recurrence rates between aortic valve replacement (AVR) and aortic root replacement (ARR) for aortic root abscesses.

Main Methods:

• Retrospective analysis of a prospectively collected infective endocarditis database (2005-2017).
• Inclusion criteria: patients aged ≥18 years with intra-cardiac abscess.
• Primary outcome: 30-day mortality; secondary outcomes: re-infection, re-operation, and long-term mortality.

Main Results:

• Fifty-nine patients with intra-cardiac abscess were identified; 75% underwent surgery.
• Thirty-day mortality was associated with *S. aureus* infection, not surgical approach.
• One-year and five-year survival in operated patients was 66% and 59%, respectively.
• No relapses occurred, but six late recurrences were observed.
• Outcomes were similar for AVR versus ARR in patients with aortic root abscess.

Conclusions:

• Unoperated patients with intra-cardiac abscess have very poor survival.
• Surgical outcomes (AVR vs. ARR) for aortic root abscesses are comparable when tailored to patient factors and operative findings.