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Heart 1999;81:177-181 ( February )
a Service de
Cardiologie, CHU Nancy-Brabois, 54500 Vandoeuvre-lès-Nancy, France, b Département des Maladies Infectieuses, CHU
Nancy-Brabois, c Service de Chirurgie Cardiaque, CHU
Nancy-Brabois
Correspondence to: Dr Danchin. email: n.danchin{at}chu-nancy.fr
Accepted for publication 7 September 1998
Objective
To
assess the long term prognostic significance of aortic valve ring
abscess in patients with aortic endocarditis.
PatientsA
consecutive series of 75 patients who had surgery for aortic infective
endocarditis between 1981 and 1989; 35 had aortic ring abscesses (group
1) and 40 did not (group 2). Mean age did not differ between the two
groups. Prosthetic valve endocarditis was present in 17% of group 1 and 5% of group 2. Pneumococcal or 
haemolytic streptococcal
endocarditis was more common in patients with native valve endocarditis
who had aortic ring abscesses (20% v 5%).
DesignCohort analysis.
ResultsIn-hospital
mortality (11.4% v 7.5%) and 10 year
survival (56% v 66%) were not
significantly different between groups 1 and 2. In patients with native
valve endocarditis, 10 year survival was 62% and 66%, respectively
for patients with or without ring abscess, and 10 year
reintervention-free survival was 38% v 58% (p = 0.11). In these patients, the presence of an intercurrent illness, severe congestive heart failure before surgery, and use of
valved conduits for surgical treatment were predictors of poorer long
term survival. At follow up residual aortic regurgitation was
documented in 72% of patients in group 1 and 26% in group 2 (p < 0.01).
ConclusionsAortic
valve ring abscess is not an independent marker of poor long term
outcome in patients with infective endocarditis. However, as residual
aortic regurgitation appears frequent at follow up, specific surgical
techniques should be considered in patients with paravalvar abscesses.
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