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. 2022 Jul;37(7):1917-1925.
doi: 10.1111/jocs.16464. Epub 2022 Apr 5.

Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess

William M Harris  1 , Shubhra Sinha  1 , Massimo Caputo  1 , Gianni D Angelini  1 , Eltayeb M Ahmed  1 , Cha Rajakaruna  1 , Umberto Benedetto  1 , Hunaid A Vohra  1
Affiliations

Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess

William M Harris et al. J Card Surg. 2022 Jul.

Abstract

Objectives: To evaluate the impact of aortic root abscess (ARA) on the postoperative outcomes of surgically managed infective endocarditis (IE) and to inform optimal surgical approach.

Methods: Between 2009 and 2020, 143 consecutive patients who underwent surgical management for aortic-valve IE were included in a retrospective cohort study. Multivariable and propensity-weighted analyses were used to adjust for demographic imbalances between those without (n = 93; NARA) and with an ARA (n = 50). Additionally, empirical subgroup analysis appraised the two most used surgical techniques; patch reconstruction (PR) and aortic root replacement (ARR).

Results: Demographic characteristics were similar between ARA and NARA except for logistic EuroSCORE, previous valve surgery, and multivalvular infection. In-hospital mortality was 8% and 12% in NARA and ARA, respectively (p = .38), with mortality rates consistently nonsignificantly higher in ARA across all time periods. The overall reoperation rate was also higher in ARA (27% vs. 14%; p = .09) and ARA was shown to be associated with late reoperation (odds ratio [OR] = 2.74; 95% confidence interval [CI] = 1.18-6.36). Patients treated with an ARR showed a 16% increase in late mortality when compared with PR (40% vs. 24%; p = .27) and a 17% lower reoperation rate (14% vs. 31%; p = .24). Propensity-weighted analysis identified ARR as a significant protective factor for reoperation (hazard ratio = 0.05; 95% CI = 0.01-0.34).

Conclusions: The presence of an ARA in aortic valve endocarditis was not associated with significantly higher early and late mortality but is linked with a higher reoperation rate at our institution. ARR in ARA is protective from reoperation so should be considered best practice in this setting.

Keywords: aortic root abscess; aortic root replacement; infective endocarditis; patch reconstruction.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Surgeon's view showing the ventricular surface of a bio‐prosthetic aortic valve studded with vegetations with florid endocarditis and root abscess. (B) Similar view after excision of the valve and repair of the abscess cavity with bovine pericardial patches in the noncoronary and left coronary sinuses.
Figure 2
Figure 2
Kaplan–Meier curves show (A) survival from death and (B) survival from reoperation in patients with and without an ARA. ARA, aortic root abscess.
Figure 3
Figure 3
Kaplan–Meier curves show (A) survival from death and (B) survival from reoperation for ARA patients treated with an ARR versus PR. ARA, aortic root abscess; PR, patch reconstruction.
See this image and copyright information in PMC

Comment in

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