Document Detail


Surgical treatment of paravalvular abscess: long-term results.
MedLine Citation:
PMID:  17140802     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine the outcomes of surgery for active infective endocarditis with paravalvular abscess. METHODS: Paravalvular abscess was defined as infective necrosis of the valve annulus that required patch reconstruction before implanting a new valve. Of 383 patients with active infective endocarditis who underwent surgical treatment, 135 (35%) had paravalvular abscess. Patients' mean age was 51+/-16 years and 68% were men. The infected valve was native in 69 patients and prosthetic in 66. The abscess involved the aortic annulus in 73 patients, the mitral annulus in 27, the aortic and mitral annuluses in 33, and the aortic and tricuspid and/or pulmonary annuluses in 2. Surgery consisted of radical resection of the abscess, reconstruction of the annulus with patches and valve replacement. Mean follow-up was 6.2+/-5.2 years and complete. RESULTS: There were 21 (15.5%) operative deaths. Preoperative shock and abscess in the aortic and mitral annuluses were independent predictors of operative death. There were 34 (25%) late deaths. Survival at 15 years was 43+/-6% for all patients, 50+/-8% for native valve endocarditis and 35+/-9% for prosthetic (p=0.41). Age by increments of 5 years and recurrent endocarditis were independent predictors of late death. There were 16 episodes of recurrent endocarditis in 15 patients, and the freedom from recurrent endocarditis was 82+/-4% at 15 years. Fifteen reoperations were performed in 14 patients. Freedom from reoperation was 72+/-9% at 15 years. CONCLUSIONS: Surgery for active endocarditis with paravalvular abscess was associated with high operative mortality, particularly in patients in shock and abscess of both mitral and aortic annuluses. Long-term survival was adversely affected by age and recurrent bouts of endocarditis.
Authors:
Tirone E David; Tommaso Regesta; Gheorghe Gavra; Susan Armstrong; Manjula D Maganti
Publication Detail:
Type:  Journal Article     Date:  2006-11-30
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  31     ISSN:  1010-7940     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-15     Completed Date:  2007-03-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  43-8     Citation Subset:  IM    
Affiliation:
Peter Munk Cardiac Centre at University Health Network, University of Toronto, Toronto, Ont., Canada. tirone.david@uhn.on.ca
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MeSH Terms
Descriptor/Qualifier:
Abscess / surgery*
Adult
Aged
Aortic Valve / surgery
Electrocardiography
Endocarditis, Bacterial / surgery*
Epidemiologic Methods
Female
Heart Valve Diseases / surgery*
Heart Valve Prosthesis
Humans
Male
Middle Aged
Prosthesis-Related Infections / surgery
Recurrence
Reoperation
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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