HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tirone E. David Tommaso Regesta Gheorghe Gavra Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by David, T. E. Articles by Maganti, M. D. Search for Related Content PubMed PubMed Citation Articles by David, T. E. Articles by Maganti, M. D. Related Collections Cardiac - other Valve disease

Eur J Cardiothorac Surg 2007;31:43-48. doi:10.1016/j.ejcts.2006.10.036
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Surgical treatment of paravalvular abscess: long-term results

Peter Munk Cardiac Centre at University Health Network, University of Toronto, Toronto, Ont., Canada

Received 19 August 2006; received in revised form 20 October 2006; accepted 24 October 2006.

^_* Corresponding author. Address: 200 Elizabeth St. 4N-457, Toronto, Ont. M5G 2C4, Canada. Tel.: +1 416 340 5062; fax: +1 416 340 4020. (Email: tirone.david{at}uhn.on.ca).

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.

Key Words: Heart valve disease • Infective endocarditis • Paravalvular abscess

This article has been cited by other articles:

				Endorsed by the European Society of Clinical Micro, Authors/Task Force Members, G. Habib, B. Hoen, P. Tornos, F. Thuny, B. Prendergast, I. Vilacosta, P. Moreillon, M. de Jesus Antunes, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC) Eur. Heart J., October 1, 2009; 30(19): 2369 - 2413. [Full Text] [PDF]

				A. M. Sheikh, A. M. Elhenawy, M. Maganti, S. Armstrong, T. E. David, and C. M. Feindel Outcomes of double valve surgery for active infective endocarditis J. Thorac. Cardiovasc. Surg., July 1, 2009; 138(1): 69 - 75. [Abstract] [Full Text] [PDF]

				S. Lehmann, T. Walther, S. Leontyev, J. Kempfert, J. Garbade, M. A. Borger, and F. W. Mohr The Toronto Root Bioprosthesis: Midterm Results in 186 Patients. Ann. Thorac. Surg., June 1, 2009; 87(6): 1751 - 1756. [Abstract] [Full Text] [PDF]

				L. M. Fedoruk, W. R. E. Jamieson, H. Ling, J. S. MacNab, E. Germann, S. S. Karim, and S. V. Lichtenstein Predictors of recurrence and reoperation for prosthetic valve endocarditis after valve replacement surgery for native valve endocarditis. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 326 - 333. [Abstract] [Full Text] [PDF]

				A. M. Sheikh, A. M. Elhenawy, M. Maganti, S. Armstrong, T. E. David, and C. M. Feindel Outcomes of surgical intervention for isolated active mitral valve endocarditis. J. Thorac. Cardiovasc. Surg., January 1, 2009; 137(1): 110 - 116. [Abstract] [Full Text] [PDF]

				G. Krasopoulos, T. E. David, and S. Armstrong Custom-tailored valved conduit for complex aortic root disease J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 3 - 7. [Abstract] [Full Text] [PDF]

				M. A. Borger, K. Prasongsukarn, S. Armstrong, C. M. Feindel, and T. E. David Stentless Aortic Valve Reoperations: A Surgical Challenge Ann. Thorac. Surg., September 1, 2007; 84(3): 737 - 744. [Abstract] [Full Text] [PDF]