Straw, S orcid.org/0000-0002-2942-4574, Baig, MW, Mishra, V et al. (6 more authors) (2022) Surgical techniques and outcomes in patients with intra-cardiac abscesses complicating infective endocarditis. Frontiers in Cardiovascular Medicine, 9. 875870. ISSN 2297-055X
Abstract
Background: An intra-cardiac abscess is a serious complication of both native (NV-IE) and prosthetic valve infective endocarditis (PV-IE). Despite being an accepted indication for surgery, controversies remain regarding the optimal timing and type of operation. We aimed to report the outcomes of patients managed for intra-cardiac abscesses over more than a decade.
Methods: Patients aged ≥18 years managed for intra-cardiac abscess between 1 January 2005 and 31 December 2017 were identified from a prospectively collected IE database. The primary outcome was 30-day mortality in operated patients and secondary outcomes were freedom from re-infection, re-operation and long-term mortality comparing those patients with aortic root abscess who underwent aortic valve replacement (AVR) and those who received aortic root replacement (ARR).
Results: Fifty-nine patients developed an intra-cardiac abscess, and their median age was 55 (43–71) years; among them, 44 (75%) were men, and 10 (17%) were persons who injected drugs. Infection with beta-haemolytic streptococci was associated with NV-IE (p = 0.009) and coagulase-negative staphylococci with PV-IE (p = 0.005). Forty-four (75%) underwent an operation, and among those with aortic root abscess, 27 underwent AVR and 12 ARR. Thirty-day mortality was associated with infection with S. aureus (p = 0.006) but not the type or timing of the operation. Survival in operated patients was 66% at 1 year and 59% at 5 years. In operated patients, none had a relapse, although six developed late recurrence. Freedom from infection, re-operation and long-term mortality were similar in patients undergoing AVR compared to ARR.
Conclusion: Patients diagnosed with intra-cardiac abscess who were not operated on had very poor survival. In those who underwent an operation, either by AVR or ARR based upon patient factors, imaging and intra-operative findings outcomes were similar.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | Copyright © 2022 Straw, Baig, Mishra, Gillott, Witte, Van Doorn, Ferrara, Javangula and Sandoe. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. |
Keywords: | infective endocarditis, abscess, aortic root abscess, cardiothoracic surgery, valve surgery |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Funding Information: | Funder Grant number British Heart Foundation FS/CRTF/20/24071 |
Depositing User: | Symplectic Publications |
Date Deposited: | 21 Apr 2022 13:02 |
Last Modified: | 25 Jun 2023 22:57 |
Status: | Published |
Publisher: | Frontiers Media |
Identification Number: | 10.3389/fcvm.2022.875870 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:185910 |