title: Early and late outcomes of complex aortic root surgery in patients with aortic root abscesses.
abstract: OBJECTIVE
  To evaluate the early and long-term outcomes in patients undergoing complex aortic root reconstructions for complicated aortic root abscesses.
  
  
  METHODS
  A total of 1199 patients underwent aortic valve surgery for aortic valve endocarditis between July 1999 and June 2012. Of these, 150 patients, who underwent complex isolated aortic root operations for aortic root abscesses, were included in this study. Radical resection of the abscess was performed in all patients followed by an aortic root replacement (ARR) in 91 (61.7%) or an aortic valve replacement with patch reconstruction of the aortic root in 59 (39.3%) patients. Prosthetic valve endocarditis was observed in 74 patients (49.3%). Logistic regression analysis identified the predictors of 30-day mortality. Estimated mean follow-up was 7.0 ± 0.5 years (range 0-12.6 years).
  
  
  RESULTS
  Mean age was 62 ± 15 years and 87% (n = 130) were male. The majority of patients (91%; n = 137) underwent urgent or emergent surgery. Overall 30-day mortality was 19% (n = 29; ARR 21%; AVR 17%; P = 0.4). Postoperative low cardiac output, stroke and dialysis developed in 10.7, 4.7 and 25.3% of patients, respectively. Sepsis was the only independent predictor of 30-day mortality (odds ratio: 2.8; 95% confidence interval: 1.1-7.3; P = 0.03). The 1-, 5- and 10-year survival was 66 ± 5, 54 ± 5 and 51 ± 6%, respectively. Overall, 9% of surviving patients required a reoperation for recurrent endocarditis resulting in a 1-, 5- and 10-year freedom from reoperation of 93 ± 2, 91 ± 3 and 85 ± 5%, respectively, which was not influenced by surgical technique used (ARR vs AVR with patch reconstruction; log rank P = 0.9).
  
  
  CONCLUSIONS
  The surgical treatment of aortic root abscess is a challenging operation and is associated with a high early morbidity and mortality. However, the long-term survival and freedom from reoperation is satisfactory.
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Sergey
authors: S
authors: Leontyev
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany pirarm@hotmail.com.
authors: Piroze M
authors: PM
authors: Davierwala
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Günther
authors: G
authors: Krögh
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Stefan
authors: S
authors: Feder
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Andreas
authors: A
authors: Oberbach
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Farhad
authors: F
authors: Bakhtiary
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Martin
authors: M
authors: Misfeld
authors: Department of Cardiac Surgery, Columbia University, New York, NY, USA.
authors: Michael A
authors: MA
authors: Borger
authors: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: D000038:Abscess / Q000401:mortality / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000379:methods / Q000401:mortality; D004696:Endocarditis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aortic root abscess; Aortic root replacement; Outcomes