title: Aortic root abscess and secondary infective mitral valve disease: results of surgical endocarditis treatment.
abstract: OBJECTIVE
  Mortality in active infective endocarditis (AIE) is substantial and reinfection can strongly influence outcome. Assessment of factors influencing mortality is important. We studied 108 (33%) patients suffering from root abscess out of a total of 327 AIE patients admitted to the Deutsches Herzzentrum Berlin for surgical treatment between 1996 and 2003. Among them were 53 (25.5% of all patients) who were diagnosed as having secondary infective mitral valve disease (SMVD). Mean age was 53+/-14.2 years; there were 37 men and 16 women.
  
  
  METHODS
  Risk factors were assessed on the basis of clinical, hemodynamic, echocardiographic and surgical information. Mean follow-up was 325+/-251 days with complete echocardiographic examination performed in patients with double valve surgery. The differences between groups were analyzed using Student's t-test. Multivariate analysis for the whole group suffering from abscess was performed to identify independent factors influencing mortality.
  
  
  RESULTS
  In 19 (35.8%) patients suffering from SMVD mitral valve reconstruction was undertaken and mitral valve replacement was performed in 34 (64.2%) patients. There were 27 patients treated with a Shelhigh prosthesis: 18 with double valve replacement (both Shelhigh) and nine with an aortic Shelhigh prosthesis and concomitant mitral valve reconstruction. Homografts were used in 17 patients, with mitral reconstruction in 10 and a stented mitral prosthesis in seven. In nine cases two stented valve prostheses were used. The calculated mean Doppler gradient for homografts and Shelhigh in aortic position was 12 (+/-5.7) and 15 (+/-4.6), respectively (NS). The following predisposing factors for mortality were assessed: severe damage of aortic annulus (OR 4.65, CI 1.22-17.1, P=0.0159); septic shock (OR 3.44, CI 0.85-13.9, P=0.07) and poor ejection fraction (<40%), and dilated LV.
  
  
  CONCLUSIONS
  Excessive mortality reaching 29% was noted in patients suffering from AIE with aortic ring abscess and SMVD requiring double valve surgery. Double valve surgery with semi-stented Dacron-free valve prostheses is associated with a low rate of reinfection and good function of the implants. The most potent independent risk factors for death were septic shock and severe aortic root destruction.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. siniawski@dhzb.de
authors.forename: Henryk
authors.initials: H
authors.lastname: Siniawski
authors.forename: Onnen
authors.initials: O
authors.lastname: Grauhan
authors.forename: Michael
authors.initials: M
authors.lastname: Hofmann
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.forename: Charles
authors.initials: C
authors.lastname: Yankah
authors.forename: Hans
authors.initials: H
authors.lastname: Lehmkuhl
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000038:Abscess / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D004697:Endocarditis, Bacterial / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D016277:Ventricular Function, Left