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European Heart Journal 2000 21(6):490-497; doi:10.1053/euhj.1999.1877
Copyright © 2000 by the European Society of Cardiology.
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Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess—11 year results

C Knosallaf1, Y Weng, A.C Yankah, H Siniawski, J Hofmeister, R Hammerschmidt, M Loebe and R Hetzer

Department of Cardiothoracic and Vascular Surgery, German Heart Institute, Berlin, Germany

revised August 3, 1999; accepted August 4, 1999

Abstract

Aims The aim of the study was to evaluate the long-term results of allograft and prosthetic valve replacement in the treatment of infective aortic valve endocarditis with periannular abscess.

Methods Between March 1988 and March 1996, 65 patients underwent surgery for active aortic valve endocarditis and paravalvular abscess. The indications for surgery were congestive heart failure, systemic emboli and atrioventricular block III. The pre-operative evaluation was performed with transoesophageal echocardiography. Aortic valve replacement was performed with allografts in 47 cases, with mechanical valves in 15, and bioprosthetic valves in three cases. All patients with total ventricular–aortic dehiscence and prosthetic valve endocarditis were treated with allografts.

Results The 30-day mortality rate was 23·5% in the prosthetic group, when compared with 8·5% in the patients treated with allografts. The rate of recurrent valve infections during the 11-year follow-up period was 27·1% in the prosthetic group and 3·2% in the allograft group. The actuarial 11-year survival rate was 82·1% in the allograft group and 64·7% in the prosthetic group.

Conclusion Aortic allografts are an effective treatment for infective aortic valve endocarditis with associated periannular abscess. The operative mortality and recurrent infection rates are lower than in the prosthetic group, resulting in a significantly higher survival rate. Diagnosis and surgical management of these cases should be based on pre-operative transoesophageal echocardiography.

Key Words: Aortic valve, endocarditis, allograft, periannular abscess, echocardiography

f1 Correspondence: Christoph Knosalla, MD, German Heart Institute Berlin, Department of Cardiothoracic and Vascular Surgery, Augustenburger Platz 1, D-13353 Berlin, Germany.

References

  1. Ergin MA, Raissi S, Follis F, Lansman SL, Griepp RB. Annular destruction in acute bacterial endocarditis-surgical techniques to meet the challenge. J Thorac Cardiovasc Surg. 1989;97:755–763[Abstract]
  2. Stinson EB. Surgical treatment of infective endocarditis. Prog Cardiovasc Dis. 1979;22:145–152[CrossRef][ISI][Medline]
  3. Daniel WG, Mügge A, Martin RP. Improvement in the diagnosis of abscesses associated wuth endocarditis by transesophageal echocardiography. N Engl J Med. 1991;324:795–800[Abstract]
  4. Karalis DG, Bansal RC, Hauck AJ. Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis-clinical and surgical implications. Circulation. 1992;86:353–362[Abstract/Free Full Text]
  5. Ross DN. Homograft replacement of the aortic valve. Lancet. 1962;2:487[ISI][Medline]
  6. Ross D. Aortic root replacement with a cardiac allograft. The infected aortic root. Yankah AC, Hetzer R, Miller DC. Cardiac Valve Allografts 1962–1987. Darmstadt: Springer Verlag; 1988. p. 167
  7. Knosalla C, Weng Y, Yankah AC, Hofmeister J, Hetzer R. Using allograft material to treat mycotic aneurysms of the thoracic aorta. Ann Thorac Surg. 1996;61:1146–1152[Abstract/Free Full Text]
  8. Schüler S, Yankah AC, Hetzer R. Allogeneic valve procurement in cardiac transplantation. Yankah AC, Hetzer R, Miller DC, Ross DN, Sommerville J, Yacaoub MH. Cardiac valve allografts 1962–1987. New York: Springer; 1988. p. 13–15
  9. Yankah AC, Hetzer R. Procurement and viability of cadiac valve allografts. Yankah AC, Hetzer R, Miller DC, Ross DN, Sommerville J, Yacoub MH. Cardiac Valve Allografts 1962–1987. New York: Springer; 1988. p. 23–26
  10. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc. 1958;53:457–481[CrossRef][ISI]
  11. Wallace AG, Young WG, Osterhout S. Treatment of acute bacterial endocarditis by valve excision and replacement. Circulation. 1965;31:450–453[Abstract/Free Full Text]
  12. Oakley CM. Perivalvular abscess in infective endocarditis. Eur Heart J. 1999;20:170–171[ISI][Medline]
  13. Anrett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation. 1976;54:140–145[Abstract/Free Full Text]
  14. McGriffin DC, Kirklin JK. The impact of aortic valve homografts on the treatment of aortic prosthetic valve endocarditis. Sem Thorac Cardiovasc Surg. 1995;7:25–31[Medline]
  15. Symbas PN, Vlasis SE, Zacharopoulos L, Lutz JF. Acute endocarditis: surgical treatment of aortic regurgitation and aortico-left ventricular discontinuity. J Thorac Cardiovasc Surg. 1982;84:291–296[Abstract]
  16. Reitz BA, Stinson Eb, Watson DC. Translocation of the aortic valve for prosthetic valve endocarditis. J Thorac Cardiovasc Surg. 1981;81:212–218[Abstract]
  17. Frantz PT, Murray GF, Wilcox BR. Surgical management of left ventricular discontinuity complicating bacterial endocarditis. Ann Thorac Surg. 1987;29:1–7
  18. Watanabe G, Haverich A, Speier R, Dressler C, Borst HG. Surgical treatment of active infective endocarditis with paravalvular involvement. J Thorac Cardiovasc Surg. 1994;107:171–177[Abstract/Free Full Text]
  19. Kirklin JK, Kirklin JW, Pacifico AD. Aortic valve endocarditis with aortic root abscess cavity: Surgical treatment with aortic valve homograft. Ann Thorac Surg. 1988;45:674–677[Abstract]
  20. Lau JK, Robles A, Cherian A, Ross DN. Surgical treatment of prostetic endocarditis: aortic root replacement using a homograft. J Thorac Cardiovasc Surg. 1984;87:712–716[Abstract]
  21. Dearani JA, Orszulak TA, Schaff HV, Daly RC, Anderson BJ, Danielson GK. Results of allograft aortic valve replacement for complex endocarditis. J Thorac Cardiovasc Surg. 1997;113:285–291[Abstract/Free Full Text]
  22. Glazier JJ, Verwilghen J, Donaldson RM, Ross DN. Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement. J Am Coll Cardiol. 1991;17:1177–1182[Abstract]
  23. Bedi HS, Farnsworth AE. Homograft aortic root replacement for destructive prosthetic endocarditis. Ann Thorac Surg. 1993;55:386–388[Abstract]
  24. McGriffin DC, Galbraith AJ, McLachlan GJ. Aortic valve infection: Risk factors for death and recurrent endocarditis after aortic valve replacement. J Thorac Cardiovasc Surg. 1992;104:291–296
  25. Daicoff GR, Botero LM, Quintessenza JA. Allograft replacement of the aortic valve versus the miniroot and valve. Ann Thorac Surg. 1993;55:855–859[Abstract]
  26. Petterson G, Tingleff J, Joyce FS. Treatment of aortic valve endocarditis with the Ross operation. Eur J Cardiothorac Surg. 1998;13:678–684
  27. Oswalt JD, Dewan SJ. Aortic infective endocarditis managed by the Ross procedure. J Heart Valve Dis. 1993;2:380–384[Medline]

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