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European Heart Journal 1999 20(3):232-241; doi:10.1053/euhj.1998.1240
Copyright © 1999 by the European Society of Cardiology.
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Perivalvular abscesses associated with endocarditis

Clinical features and prognostic factors of overall survival in a series of 233 cases

R. Choussatf1, D. Thomas, R. Isnard, MichelP.-L. , B. Iung, G. Hanania, P. Mathieu, M. David, T. du Roy de Chaumaray, G. De Gevigney, H. Le Breton, Y. Logeais, E. Pierre-Justin, C. de Riberolles, Y. Morvan and N. Bischoff

Department of Cardiology, Centre Hospitalier Universitaire Pitié-Salpétrière, Paris, France

Received July 6, 1998; accepted July 12, 1998

Abstract

Aims

The purposes of this study were to determine the clinical features and to identify prognostic factors of abscesses associated with infective endocarditis.

Methods and Results

During a 5-year period from January 1989, 233 patients with perivalvular abscesses associated with infective endocarditis were enrolled in a retrospective multicentre study. Of the patients, 213 received medical–surgical therapy and 20 medical therapy alone. No causative microorganism could be identified in 31% of cases. Sensitivity for the detection of abscesses was 36 and 80%, respectively using transthoracic and transoesophageal echocardiography. Surgical treatment consisted of primary suture of the abscess (38%), insertion of a felt aortic or mitral ring using Teflon or pericardium (42%), or debridment of the abscess cavity (20%). The 1 month operative mortality was 16%. Actuarial rates for overall survival at 3 and 27 months in operated patients were 75±10% and 59±11%, respectively. Increasing patient age, staphylococcal infection, and fistulization of the abscess were found to be independent risk factors in both 1 month and overall operative mortality. Renal failure was a risk factor predictive of operative mortality at 1 month, whereas uncontrolled infection and circumferential abscess were regarded as risk factors predictive of overall operative mortality.

Conclusion

The data determined prognostic factors of abscesses associated with infective endocarditis.

Key Words: Infective endocarditis • abscess • prognostic factors

f1 Correspondence: R. Choussat, Department of Cardiology, Centre Hospitalier Universitaire Pitié-Salpétrière, 47 boulevard de l’Hôpital, 75013 Paris, France.

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