Study of Surgical Outcomes for Infective Endocarditis with Annular Abscess

Shota Hasegawa, Naomichi Uchida, Hirohisa Murakami, Masamichi Matsumori, Masato Yoshida, Nobuhiko Mukouhara

Hyogo Brain and Heart Center, Himeji, Japan

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

Abstract

【Purpose】Annular abscesses are serious complications of infectious endocarditis (IE), and the timing and method of surgery are controversial. We retrospectively studied the operations on annular abscesses at our institution.【Method】In 150 patients who were operated for IE between 2001 and 2017, there were 23 cases (aortic:10, mitral 6, both 7, aortic root 3) including five cases of prosthetic valve endocarditis (PVE) with an annular abscess (15 males; mean age 64.3±17 years). Preoperatively, five cases were in NYHA class III; 11 cases were in class IV; with one case in shock.We performed emergent operations in 17 cases, urgent operations in 5 cases and elective operation in one case. In twelve cases preoperatively presented with cerebral infarctions, the eight cases were operated in the acute phase within two weeks using nafamostat mesilate to establish cardiopulmonary bypass. Operative procedure was fundamentally a radical debridement to an abscess cavity as possible and reconstruction to defective portions using pericardial patch (N=19, 83%). Three cases involved the A-M continuity. Aortic root replacement was performed in eight cases.【Results】Four cases (17%) died in-hospital(mean 109.5 days after surgery) caused by heart failure with sepsis in three cases and pneumonia in one case. Postoperative neurological symptoms were improved in one case, unchanged in eight cases, and deteriorated in three cases. There were three cases (8.7%) of postoperative PVE due to annular abscesses and two paravalvular leaks. Patients were discharged 25-131 (mean 64.6) days after surgery. The mean follow-up period was 27.4±26 months. There were seven late deaths. Event-free survival was 52.2% at five years.【Conclusion】It was important to perform prompt surgery as soon as possible, taking account of cerebral complications, with aggressive debridement and reconstruction of the infected tissue for IE with annular destruction.