Root abscess in the setting of infectious endocarditis: Short- and long-term outcomes

J Thorac Cardiovasc Surg. 2021 Oct;162(4):1049-1059.e1. doi: 10.1016/j.jtcvs.2019.12.140. Epub 2020 Apr 13.

Abstract

Objectives: To evaluate the influence of an aortic root abscess on perioperative outcomes and long-term survival in patients with active infectious endocarditis that was treated surgically.

Methods: From 1996 to 2017, 336 consecutive patients were treated with aortic valve or root replacement for infective endocarditis, including patients with (n = 179) or without (n = 157) a root abscess. Data were obtained from the Society of Thoracic Surgeons data warehouse, through chart review, patient surveys, and National Death Index data.

Results: Demographic characteristics were similar between groups except the root abscess group had a significantly lower prevalence of congestive heart failure and higher rates of prosthetic valve endocarditis. The abscess group had significantly more aortic root replacements as well as longer cardiopulmonary bypass and crossclamp times. Operative mortality was 8.4% and 3.8% (P = .11) for the abscess and no abscess groups, respectively. Nevertheless, the root-abscess group had prolonged ventilation and longer intensive care unit stays. Kaplan-Meier survival was similar between root abscess and no abscess groups (10-year survival 41% vs 43%; P = .35). Significant risk factors for all-time mortality included age greater than 70 (hazard ratio [HR], 2.85; 95% confidence interval [CI], 1.55, 5.24), the presence of a root abscess (HR, 1.42; 95% CI, 1.02, 1.96), intravenous drug use (HR, 1.81; 95% CI, 1.13, 2.89), congestive heart failure (HR, 1.72; 95% CI, 1.22, 2.42), renal failure requiring dialysis (HR, 3.26; 95% CI, 2.30, 4.64), liver disease (HR, 3.04; 95% CI, 1.65, 5.60), and postoperative sepsis (HR, 3.00; 95% CI, 1.30, 6.93). The 10-year rate of reoperation was also similar between groups (5.9% vs 7.9%).

Conclusions: Thorough and extensive debridement is critical for successful treatment of active endocarditis with root abscess. Bioprosthetic stented and stentless valves are valid conduits to treat endocarditis with root abscess.

Keywords: aortic root abscess; aortic root replacement; aortic valve replacement; endocarditis; operative outcome.

MeSH terms

  • Abscess* / diagnosis
  • Abscess* / etiology
  • Abscess* / surgery
  • Aortic Valve* / pathology
  • Aortic Valve* / surgery
  • Endocarditis* / complications
  • Endocarditis* / diagnosis
  • Endocarditis* / mortality
  • Endocarditis* / surgery
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / epidemiology
  • Heart Valve Prosthesis / classification
  • Heart Valve Prosthesis / statistics & numerical data
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / methods
  • Humans
  • Kaplan-Meier Estimate
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / mortality
  • Long Term Adverse Effects* / surgery
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / mortality
  • Postoperative Complications* / surgery
  • Prosthesis-Related Infections* / diagnosis
  • Prosthesis-Related Infections* / epidemiology
  • Reoperation / methods
  • Reoperation / statistics & numerical data
  • Risk Factors
  • Substance Abuse, Intravenous / epidemiology
  • United States / epidemiology