Infective Endocarditis Complicated by Paravalvular Abscess: A Surgical Challenge. An 11-Year Single Center Experience
Aim: To evaluate the impact of paravalvular abscess in the surgical management and outcome of infective endocarditis.
Methods: Retrospective review of 35 patients with paravalvular abscess due to active endocarditis operated on at 1 institution from September 1996-August 2007. Patients' mean age was 59.4 ± 12.1 years; 80% were men. 31 patients suffered from native- and 4 from prosthetic valve endocarditis. In 23 cases the affected valve was the aortic, in 7 cases the mitral, in 4 cases both (mitral and aortic), and in 1 patient the tricuspid; no abscess presence was noticed by pulmonal annuluses. Surgical procedures included radical lesion-resection as well as reconstruction of the annulus with pericardial patches. Most of the patients were preoperatively in New York Heart Association (NYHA)-class III-IV. Follow-up was 100% complete with a maximum of 11.25 years.
Results: Early mortality (30 days) was 11.4% (n = 4). The 11-year overall survival rate was 68.7 ± 9% (76.1% for aortic valve patients and 26.9% for mitral valve patients (P = .15). With regard to the type of prosthetic devices, the survival rates at 11.25 years were 74.2% for mechanical, 80% for biological, and 45.6% for other/reconstructive (P = .6). There were no episodes of recurrent endocarditis; hence freedom of recurrent endocarditis at 11 years was 100%. Causative microorganisms were approximately 30% Staphylococci, and MRSA seems to induce more frequent destructive lesions like paravalvular abscess.
Conclusions: Considering the severity of the onset, a radical surgical treatment delivers acceptable long-term results by acceptable operative mortality. The choice of the prosthetic device seems not to be influential in long-term survival and morbidity.
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).