Key result
Aortic root abscess was associated with higher 30-day (19.6% vs 11.3%, p=0.009) and 1-year mortality, though it was not an independent predictor of mortality in multivariable analysis.
Why the study?
Locally destructive aortic valve infective endocarditis complicated by aortic root abscess may seriously affect outcomes, and surgical repair is often challenging.
Does the presence of an aortic root abscess worsen mortality and outcomes in patients undergoing surgery for infective endocarditis?
Observational (n=665)
No
Does the presence of an aortic root abscess worsen mortality and outcomes in patients undergoing surgery for infective endocarditis?
Absolute Event Rate: 19.6% vs 11.3%
p-value: p=0.009
Patients with an aortic root abscess undergoing surgery for infective endocarditis have higher unadjusted short- and long-term mortality compared to those without abscess, though the abscess itself was not an independent predictor of mortality.
Should not yet modify surgical risk models for aortic abscess in endocarditis; leaves open independent prognostic value after multivariable adjustment.
Locally destructive infective endocarditis (IE) of the aortic valve complicated by abscess formation in the aortic root may seriously affect patients’ outcomes. Surgical repair of such conditions is often challenging. This is a single-center observational analysis of consecutive patients treated surgically for IE between 2009 and 2019. We divided the cohort into two groups considering the presence of an aortic root abscess and compared the characteristics and postoperative outcomes of patients accordingly. Moreover, we examined three different procedures performed in abscess patients regarding operative data and postoperative results: an isolated surgical aortic valve replacement (AVR), AVR with patch reconstruction of the aortic root (AVR + RR) or the Bentall procedure. The whole cohort comprised 665 patients, including 140 (21.0%) patients with an aortic root abscess and 525 (78.9%) as the control group. The abscess group of patients received either AVR (66.4%), AVR + RR (17.8%), or the Bentall procedure (15.7%). The mean age in the whole cohort was 62.1 ± 14.8. The mean EuroSCORE II was 8.0 ± 3.5 in the abscess group and 8.4 ± 3.7 in the control group (p = 0.259). The 30-day and 1-year mortality rates were 19.6% vs. 11.3% (p = 0.009) and 40.1% vs. 29.6% (p = 0.016) in the abscess compared to the control group. The multivariable regression analysis did not reveal aortic root abscess as an independent predictor of mortality. Rather, age > 60 correlated with 30-day mortality and infection with Streptococcus spp. correlated with 1-year mortality. In the analysis according to the performed procedures, KM estimates exhibited comparable long-term survival (log-rank p = 0.325). IE recurrence was noticed in 12.3% of patients after AVR, 26.7% after AVR + RR and none after Bentall (p = 0.069). We concluded that patients with an aortic root abscess suffer worse short and long-term outcomes compared to other IE patients. The post-procedural survival among ARA patients did not significantly vary based on the procedures performed.
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Elderia et al. (2024) conducted an observational in Infective endocarditis (n=665). Aortic root abscess vs. No aortic root abscess was evaluated on 30-day mortality (p=0.009). Aortic root abscess was associated with higher 30-day (19.6% vs 11.3%, p=0.009) and 1-year mortality, though it was not an independent predictor of mortality in multivariable analysis.
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