Surgery for paravalvular abscess in children

Damien M Wu; Igor E Konstantinov; Michael Z L Zhu; Shuta Ishigami; Kuntal Roy Chowdhuri; Christian P Brizard; Edward Buratto

doi:10.1016/j.xjon.2023.08.027

Surgery for paravalvular abscess in children

JTCVS Open. 2023 Oct 29:16:648-655. doi: 10.1016/j.xjon.2023.08.027. eCollection 2023 Dec.

Authors

Damien M Wu^{1

2

3}, Igor E Konstantinov^{1

2

3

4}, Michael Z L Zhu^{1

2

3}, Shuta Ishigami^{1

2

3}, Kuntal Roy Chowdhuri^{1

2

3}, Christian P Brizard^{1

2

3

4}, Edward Buratto^{1

2

3}

Affiliations

¹ Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.
² Department of Paediatrics, University of Melbourne, Melbourne, Australia.
³ Murdoch Children's Research Institute, Melbourne, Australia.
⁴ Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.

Abstract

Objective: To investigate the outcomes of surgery in children with paravalvular abscess at our institution.

Methods: A retrospective review of all patients who underwent surgery for paravalvular abscess was performed.

Results: Between 1989 and 2020, 30 patients underwent surgery for paravalvular abscess, of whom 5 (16.7%) had an intracardiac fistula and 6 (20.0%) had a pseudoaneurysm. Aortic annulus abscesses were most common, occurring in 23 patients (76.7%). Aortic root replacement was performed in 17 patients (56.7%), root reconstruction was performed in 4 (13.3%), and reconstruction of the central fibrous body was required in 5 (16.7%). Postoperatively, 7 patients (23.3%) required extracorporeal membrane oxygenation (ECMO) support, and 1 patient (3.3%) required permanent pacemaker insertion. There were 6 early deaths, 5 of whom were on ECMO, and no late deaths, with a 15-year survival of 79.7% (95% confidence interval [CI], 60.2%-90.3%). Deaths were from sudden cardiac arrest resulting in brain death in 3 patients, inability to wean from ECMO due to severe cardiac dysfunction in 2 patients, and cerebral mycotic aneurysm and hemorrhage in 1 patient. Freedom from reoperation was 40.0% (95% CI, 17.0%-62.3%) at 15 years Reoperation due to recurrence was rare, occurring in only 2 patients (6.7%). Streptococcus pneumoniae (hazard ratio [HR], 9.2; 95% CI, 1.6-51.7) and preoperative shock (HR, 6.4; 95% CI, 1.3-32.0) were associated with mortality. Central fibrous body reconstruction was associated with reoperation (HR, 4.4; 95% CI, 1.2-16.1).

Conclusions: Although paravalvular abscess in children is associated with high early mortality, hospital survivors have good long-term survival. Reoperation is frequent, but is rarely due to recurrence of endocarditis.

Keywords: cardiac surgery; children; infective endocarditis; paravalvular abscess.