[Surgical therapy of acute endocarditis of the aortic valve with paravalvular abscess. 7 years experiences].
Operative treatment of acute valve endocarditis with paravalvular abscess remains a surgical challenge. The aim of the study was gaining insights into the influence of our surgical strategy on the short- and midterm results. Over a period of 7 years 18 patients underwent surgical treatment of a paravalvular abscess accompanying their acute aortic valve endocarditis. All patients ranged preoperative in the NYHA class IV. Eleven patients suffered from native and 7 from prosthetic aortic valve endocarditis. Staphylococcus aureus was found to have caused the infection in 50% of the cases. Surgical therapy consisted in all patients of thorough resection of the infected tissue followed by reconstruction of the defect with the aid of autologus pericardial patch and replacement of the aortic valve using a prosthesis. Although the rate of complications continued high early lethality remained at 5.5%. Midterm results proved to be very good with a follow-up of 44 month. Both lethality and the reoperation rate stayed at 0%. The operative risk of acute aortic valve endocarditis with paravalvular abscess is high but acceptable. Should a paravalvular abscess be diagnosed during a case of endocarditis urgent surgical therapy is highly advisable even there is only a minor deterioration of the patient' clinical state. Radical abscess debridement in combination with exclusion of the place of resection from circulation using an autologus pericard patch is a necessary condition for achieving good results.
Vicol
Calin
C
Herzchirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 München, Deutschland. cvicol@helios.med.uni-muenchen.de
Barth
Gert
G
D000038:Abscess / Q000601:surgery*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D016459:Prosthesis-Related Infections / Q000401:mortality / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D013203:Staphylococcal Infections / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate