Key result
Aortic root abscess is linked to ~3.1-fold higher MACCE risk in infective endocarditis.
Why the study?
Does aortic root abscess increase major adverse cardiac and cerebrovascular events in patients surgically treated for aortic valve infective endocarditis, and does patch repair improve outcomes compared to extended surgery?
Cohort (n=158)
No
Does aortic root abscess increase major adverse cardiac and cerebrovascular events in patients surgically treated for aortic valve infective endocarditis, and does patch repair improve outcomes compared to extended surgery?
Aortic root abscess is a strong marker of adverse prognosis in surgically treated aortic valve infective endocarditis, and patch repair offers lower mortality and MACCE than extended root surgery in patients with suitable anatomy.
Answers are grounded in this paper and cite their sources.
Aortic root abscess signals high MACCE risk after aortic valve IE surgery; patch repair leaves open preference over extended reconstruction pending randomized confirmation.
OBJECTIVE: Due to discrepancies between guidelines and expert consensus, we examined the perioperative and mid-term outcomes of aortic root abscesses to determine their prognostic significance and optimal surgical management. METHODS: We completed a single-center retrospective study of patients surgically treated for aortic valve infective endocarditis (AV IE) from 2019 to 2024. We compared outcomes in patients with and without root abscess, and among abscess cases, between patch repair and extended surgery (root reconstruction or replacement). The primary outcome was major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, heart failure (HF) readmission, and stroke). Outcomes were analyzed using Kaplan Meier estimators and Cox proportional hazards. RESULTS: Among 158 patients (57% with abscess) with a median follow-up of 1.22 years (IQR 0.13-2.53), root abscesses were associated with increased MACCE (adjusted HR 3.15 (1.51-6.59), p=0.002) and HF readmission (SHR 4.54 (1.55-13.30), p=0.006). In patients with aortic root abscess, 62 underwent patch repair and 21 underwent extended surgery. Patch repair was associated with decreased MACCE (adjusted HR 0.34 (0.15-0.74), p=0.006), all-cause mortality (p=0.002), and death at 30 days (13% vs 33%, p=0.035) compared to extended surgery. CONCLUSIONS: Aortic root abscess was associated with increased MACCE and HF readmissions compared to AV IE without abscess, identifying root abscess as a marker of adverse prognosis and supporting prompt recognition and referral in aortic valve endocarditis. Patch repair for aortic root abscesses is a safe and reasonable approach in patients with suitable anatomy compared to more extensive surgery.
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Watkins et al. (2026) conducted a cohort in Aortic valve infective endocarditis (n=158). Aortic root abscess (and patch repair in the abscess subgroup) vs. No root abscess (and extended surgery including root reconstruction or replacement in the abscess subgroup) was evaluated on Major adverse cardiac and cerebrovascular events (MACCE, composite of all-cause death, heart failure readmission, and stroke) (adjusted HR 3.15, 95% CI 1.51-6.59, p=0.002). Aortic root abscess increased MACCE (aHR 3.15; 95% CI 1.51-6.59), while patch repair reduced MACCE versus extended surgery (aHR 0.34; 95% CI 0.15-0.74; p=0.006).
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