Key result
Surgical treatment compared to medical treatment resulted in similar in-hospital mortality for patients with prosthetic (33% vs 33%) and native valve (25% vs 25%) paravalvular abscesses.
Why the study?
Do outcomes differ between patients with active infective endocarditis and a paravalvular abscess on a prosthetic valve versus a native valve, and between surgical versus medical treatment?
Cohort (n=28)
Do outcomes differ between patients with active infective endocarditis and a paravalvular abscess on a prosthetic valve versus a native valve, and between surgical versus medical treatment?
In a small cohort of patients with infective endocarditis and paravalvular abscess, there was no statistically significant difference in mortality between prosthetic and native valves, or between surgical and medical management, though age strongly predicted in-hospital mortality.
Answers are grounded in this paper and cite their sources.
Comparable mortality with surgery or medical therapy in prosthetic and native valve abscesses; leaves open optimal strategy pending randomized trials.
We investigated in-hospital and long-term mortality in 16 patients with infective endocarditis and paravalvular abscess on a prosthetic valve (6 of whom underwent surgery) and in 12 patients with infective endocarditis and paravalvular abscess on a native valve (8 of whom underwent surgery). The only significant risk factor for in-hospital mortality in patients with prosthetic or native value paravalvular abscess was age (P < 0.001). In-hospital mortality was 33% in patients with prosthetic valve paravalvular abscess undergoing surgery and 33% in patients treated medically (P = not significant). In-hospital mortality was 25% in patients with native valve paravalvular abscess undergoing surgery and 25% in patients treated medically (P = not significant). At 4.8-year follow up, survival of patients with prosthetic valve paravalvular abscess was 67% for patients treated surgically versus 40% for patients treated medically (P = not significant). At 4.8-year follow up, survival of patients with native valve paravalvular abscess was 75% for patients treated surgically versus 50% for patients treated medically (P = not significant).
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Langiulli et al. (2005) conducted a cohort in Active infective endocarditis and a paravalvular abscess (n=28). Surgical treatment vs. Medical treatment was evaluated on In-hospital mortality in patients with prosthetic valve paravalvular abscess (p=not significant). Surgical treatment compared to medical treatment resulted in similar in-hospital mortality for patients with prosthetic (33% vs 33%) and native valve (25% vs 25%) paravalvular abscesses.
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