[Results of surgical treatment of aortic root infection].
OBJECTIVE
To investigate preoperative status and results of surgery of patients with confirmed diagnosis of aortic root infection.


METHODS
We have analyzed data of 21 patients who were operated on at the Heart Surgery Center, Vilnius University, since January 1, 1997, till December 31, 2006. All these patients underwent surgery because of aortic root infection. The patients were aged 25-72 years (mean age, 53+/-14 years). There were 17 (80.9%) male patients. Sixteen patients (76%) preoperatively were in NYHA class IV. The abscesses of aortic root were confirmed preoperatively by means of esophageal echocardiography in 18 patients (86%). Blood cultures positive for Staphylococcus aureus were found in four patients (19.9%). All the patients underwent replacement of the aortic valve by mechanic prosthesis; one of these patients was reoperated because of persistent sepsis, and replacement of the aortic root with homograft was performed. The duration of follow-up of the patients was 1 to 10 years.


RESULTS
Inhospital mortality rate was 14.3%. The causes of death included sustained heart failure and sepsis. All these patients were in NYHA functional class IV preoperatively; one of these patients had culture positive for Staphylococcus aureus. Inhospital survival was 85.7%, one-year postoperative survival - 80.9%, and both five-year and ten-year survivals were 76.0%. The long-term survival was negatively influenced by recurrent infective endocarditis, heart failure, and age. Death occurred in 1 patient (11.1%) of the 9 patients who at the time of surgery were younger than 50 years and 4 patients (33.3%) of the 12 who were older than 50 years at the time of operation.


CONCLUSIONS
The infection of aortic root is not common pathology; however, it is a complicated disease. Esophageal echocardiography is an informative method while diagnosing aortic root abscesses. The inhospital mortality is increased by the heart failure persisting after the operation and sepsis. The long-term survival is decreased by preoperative infective endocarditis of the prosthesis and heart failure. The mortality rate of patients older than 50 years is 3-fold higher than mortality rate of younger ones.
Semeniene
Palmyra
P
Vilniaus universiteto Sirdies chirurgijos centras. palmyra.semeniene@santa.lt
Grebelis
Arimantas
A
Turkevicius
Gintaras
G
Nogiene
Giedre
G
Cypiene
Rasa
R
Sirvydis
Vytautas
V
D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000637:transplantation; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000401:mortality; D013203:Staphylococcal Infections / Q000150:complications; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome