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.