title: Infective endocarditis complicated by paravalvular abscess: a surgical challenge. An 11-year single center experience.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiac Surgery, Heart Center Bogenhausen, Munich, Germany. Kyriakosspili@aol.com
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Spiliopoulos
authors.forename: Ayman
authors.initials: A
authors.lastname: Haschemi
authors.forename: Gabriel
authors.initials: G
authors.lastname: Fink
authors.forename: Bernhard-Michael
authors.initials: BM
authors.lastname: Kemkes
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome