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Eur J Cardiothorac Surg 2005;27:434-440
© 2005 Elsevier Science NL

Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment

Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany

Received 17 September 2004; received in revised form 16 November 2004; accepted 1 December 2004.

^* Corresponding author. Tel: +49 30 4593 2012; fax: +49 30 4593 1003. (E-mail: siniawski{at}dhzb.de).

Objective: Mortality in active infective endocarditis (AIE) is substantial and reinfection can strongly influence outcome. Assessment of factors influencing mortality is important. We studied 108 (33%) patients suffering from root abscess out of a total of 327 AIE patients admitted to the Deutsches Herzzentrum Berlin for surgical treatment between 1996 and 2003. Among them were 53 (25.5% of all patients) who were diagnosed as having secondary infective mitral valve disease (SMVD). Mean age was 53±14.2 years; there were 37 men and 16 women. Methods: Risk factors were assessed on the basis of clinical, hemodynamic, echocardiographic and surgical information. Mean follow-up was 325±251 days with complete echocardiographic examination performed in patients with double valve surgery. The differences between groups were analyzed using Student's t-test. Multivariate analysis for the whole group suffering from abscess was performed to identify independent factors influencing mortality. Results: In 19 (35.8%) patients suffering from SMVD mitral valve reconstruction was undertaken and mitral valve replacement was performed in 34 (64.2%) patients. There were 27 patients treated with a Shelhigh prosthesis: 18 with double valve replacement (both Shelhigh) and nine with an aortic Shelhigh prosthesis and concomitant mitral valve reconstruction. Homografts were used in 17 patients, with mitral reconstruction in 10 and a stented mitral prosthesis in seven. In nine cases two stented valve prostheses were used. The calculated mean Doppler gradient for homografts and Shelhigh in aortic position was 12 (±5.7) and 15 (±4.6), respectively (NS). The following predisposing factors for mortality were assessed: severe damage of aortic annulus (OR 4.65, CI 1.22–17.1, P=0.0159); septic shock (OR 3.44, CI 0.85–13.9, P=0.07) and poor ejection fraction (<40%), and dilated LV. Conclusions: Excessive mortality reaching 29% was noted in patients suffering from AIE with aortic ring abscess and SMVD requiring double valve surgery. Double valve surgery with semi-stented Dacron-free valve prostheses is associated with a low rate of reinfection and good function of the implants. The most potent independent risk factors for death were septic shock and severe aortic root destruction.

Key Words: Double valve endocarditis • Destructive endocarditis • Secondary mitral valve endocarditis • Jet lesion • Superstentless valve substitute • Aortic root abscess

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