[Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology].
The aim of this retrospective multicenter study was to determine present characteristics of infectious endocarditis complicated by abscess and to identifying predictive factors of mortality. The files of 233 patients with infectious endocarditis complicated by perivalvular abscesses between January 1989 and December 1993 were analysed. Two hundred and thirteen patients underwent medico-surgical treatment (175 aortic and 38 mitral abscesses) and 20 patients underwent medical treatment alone (17 aortic and 3 mitral abscesses). The abscess was observed on native valves in 156 cases and valve prostheses in 77 cases. The causative organism was identified in 69% of cases : the commonest organism was the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80% respectively. The operative mortality at one month was 16%. Patients over 65 years of age, staphylococcal infection, renal failure and fistulisation of the abscess, were identified as independent predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10% and 59 +/- 11% at 27 months. An age over 65, staphylococcal infection, uncontrolled infection, circumferential abscess and fistulisation were independent predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40%: cardiac failure and fistulisation of the abscess detected by echocardiography were predictive factors of mortality on univariate analysis.
Thomas
D
D
Service de cardiologie, hôpital Tenon, Paris.
Choussat
R
R
Isnard
R
R
Michel
P L
PL
Lung
B
B
Hanania
G
G
Mathieu
P
P
du Roy de Chaumaray
T
T
de Gevigney
G
G
Le Breton
H
H
Logeais
Y
Y
Pierre-Justin
E
E
de Riberolles
C
C
Morvan
Y
Y
Bischoff
N
N
D000038:Abscess / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000382:microbiology; D002303:Cardiac Output, Low / Q000150:complications; D009202:Cardiomyopathies / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005402:Fistula / Q000382:microbiology; D005500:Follow-Up Studies; D005544:Forecasting; D006349:Heart Valve Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000601:surgery; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000601:surgery; D015996:Survival Rate