What is the clinical evidence from this study?

Study design: Cohort. Population: Active infective aortic valve endocarditis with paravalvular abscess (n=65). Intervention: Aortic valve replacement with allografts vs. Prosthetic valve replacement. Primary outcome: Actuarial 11-year survival rate.

What does this research mean for the field?

Aortic allografts provide lower operative mortality, lower recurrent infection rates, and significantly higher long-term survival compared to prosthetic valves in the treatment of active infective aortic valve endocarditis with periannular abscess. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to compare the long-term outcomes of allograft and prosthetic valve replacements in patients with infective aortic valve endocarditis with periannular abscess.

June 8, 2026Open Access

Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess—11 year results

Key Result

Allograft aortic valve replacement for infective endocarditis yielded higher 11-year survival (82.1% vs 64.7%) and lower 30-day mortality (8.5% vs 23.5%) compared to prosthetic valves.

Key Points

This study aims to compare the long-term outcomes of allograft and prosthetic valve replacements in patients with infective aortic valve endocarditis with periannular abscess.
Conducted between March 1988 and March 1996 with 65 patients undergoing surgery for infective aortic valve endocarditis and abscess.
Performed transoesophageal echocardiography for pre-operative evaluation; patients received surgery with either allografts, mechanical valves, or bioprosthetic valves.
Treatment decisions were based on indications including congestive heart failure and systemic emboli.
30-day mortality rate was 23.5% in the prosthetic group vs 8.5% in the allograft group.
Recurrent valve infections during 11-year follow-up were 27.1% in the prosthetic group compared to 3.2% in the allograft group.
Actuarial 11-year survival rate was 82.1% for allografts and 64.7% for prosthetic valves.

Study Design

Type

Cohort (n=65)

Structured PICO

Does aortic valve replacement with allografts improve survival and reduce recurrent infections compared to prosthetic valves in patients with active infective aortic valve endocarditis and periannular abscess?

Population

65 patients with active infective aortic valve endocarditis and paravalvular abscess who underwent surgery, followed for 11 years.

Exposure

Aortic valve replacement with allografts (n=47)

Comparator

Aortic valve replacement with prosthetic valves (mechanical n=15, bioprosthetic n=3)

Outcome

Actuarial 11-year survival ratehard clinical

Aortic allografts demonstrate superior long-term survival and lower rates of recurrent infection and operative mortality compared to prosthetic valves in patients with active infective aortic valve endocarditis and periannular abscess.

Main Result

Absolute Event Rate: 82.1% vs 64.7%

Abstract

AIMS: The aim of the study was to evaluate the long-term results of allograft and prosthetic valve replacement in the treatment of infective aortic valve endocarditis with periannular abscess. METHODS: Between March 1988 and March 1996, 65 patients underwent surgery for active aortic valve endocarditis and paravalvular abscess. The indications for surgery were congestive heart failure, systemic emboli and atrioventricular block III. The pre-operative evaluation was performed with transoesophageal echocardiography. Aortic valve replacement was performed with allografts in 47 cases, with mechanical valves in 15, and bioprosthetic valves in three cases. All patients with total ventricular-aortic dehiscence and prosthetic valve endocarditis were treated with allografts. RESULTS: The 30-day mortality rate was 23.5% in the prosthetic group, when compared with 8.5% in the patients treated with allografts. The rate of recurrent valve infections during the 11-year follow-up period was 27.1% in the prosthetic group and 3.2% in the allograft group. The actuarial 11-year survival rate was 82.1% in the allograft group and 64.7% in the prosthetic group. CONCLUSION: Aortic allografts are an effective treatment for infective aortic valve endocarditis with associated periannular abscess. The operative mortality and recurrent infection rates are lower than in the prosthetic group, resulting in a significantly higher survival rate. Diagnosis and surgical management of these cases should be based on pre-operative transoesophageal echocardiography.