Outcome of Surgical Treatment for Infective Endocarditis with Aortic Periannular Abscess

Mao Ting, Chih-Hsien Wang, Nai-Hsin Chi, I-Hui Wu, Shu-Chien Huang, Ron-Bin Hsu, Yih-Sharng Chen, Yih-Sharng Chen, Shoei-Shen Wang, Chung-I Chang, Hsi-Yu Yu

National Taiwan University Hospital, Taipei, Taiwan

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–B

Abstract

Objective:

Aortic periannular abscess is a serious complication of infective endocarditis. Surgical treatments include AVR with radical debridement or aortic root replacement/ reconstruction, depending on the integrity of aortic annulus/root. However, sometimes it is difficult to determine the integrity of infected aortic annulus and root. Herein we reviewed the surgical treatments for infective endocarditis with periannular abscess in our hospital, and compared the outcome and risk factors of two different surgical strategies.

Methods:

We retrospectively reviewed patients with IE and periannular abscess, who received surgery in National Taiwan University Hospital during the years 2001-2017. The patients are categorized into two groups: group 1 consisted of simple AVR with or without suture repair, representing “simple repair”; group 2 consisted of AVR with patch repair and aortic root replacement, representing “complex repair”. The risk factors, short-term mortality, mid-term mortality, and re-operation rate between the two groups were examined.

Results:

There were 17 patients in group 1 and 15 patients in group 2. There was no significant difference in pre-operative variables between the two groups, including demography, pathogen, prosthetic IE, antibiotic treatment duration, and critical pre-operative condition. The 30-day mortality was 11.8% in group 1 and 20% in group 2 (p=0.6454). The 1-year mortality was 23.5% in group 1 and 40% in group 2 (p=0.324). The re-operation rate was 23.5% in group 1 and 20.0% in group 2 (p=0.813).

Conclusions:

Surgery for periannular abscess still carries high operative mortality and re-operation rate. It is hard to predict the integrity of infected aortic annulus and root preoperatively. It seems that AVR with radical debridement has lower operative mortality and similar re-operation rate compared with the complex repair. Careful intra-operative judgement and management are warranted.