PMID- 20444680
OWN - NLM
STAT- MEDLINE
DCOM- 20100914
LR  - 20100506
IS  - 1522-6662 (Electronic)
IS  - 1098-3511 (Linking)
VI  - 13
IP  - 2
DP  - 2010 Apr
TI  - Infective endocarditis complicated by paravalvular abscess: a surgical challenge. 
      An 11-year single center experience.
PG  - E67-73
LID - 10.1532/HSF98.20081141 [doi]
AB  - 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.
FAU - Spiliopoulos, Kyriakos
AU  - Spiliopoulos K
AD  - Department of Cardiac Surgery, Heart Center Bogenhausen, Munich, Germany. 
      Kyriakosspili@aol.com
FAU - Haschemi, Ayman
AU  - Haschemi A
FAU - Fink, Gabriel
AU  - Fink G
FAU - Kemkes, Bernhard-Michael
AU  - Kemkes BM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Abscess/diagnosis/etiology/*surgery
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/surgery
MH  - Cardiac Surgical Procedures/*methods
MH  - Echocardiography
MH  - Endocarditis, Bacterial/complications/diagnosis/*surgery
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Diseases/diagnosis/etiology/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Staphylococcal Infections/diagnosis/etiology/*surgery
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2010/05/07 06:00
MHDA- 2010/09/15 06:00
CRDT- 2010/05/07 06:00
PHST- 2010/05/07 06:00 [entrez]
PHST- 2010/05/07 06:00 [pubmed]
PHST- 2010/09/15 06:00 [medline]
AID - K2067055M827H244 [pii]
AID - 10.1532/HSF98.20081141 [doi]
PST - ppublish
SO  - Heart Surg Forum. 2010 Apr;13(2):E67-73. doi: 10.1532/HSF98.20081141.