Surgical treatment for aortic periannular abscess_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MA Nan , DING Shiao ,  MEI Ju , TANG Min , JIANG Zhaolei , ZHANG Yunjiao , ZHANG Li

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P. R. China;

Corresponding author：

MEI Ju, Email: meiju@xinhuamed.com.cn

Keywords：

Periannular abscess; infective endocarditis; surgery

DOI：

10.7507/1007-4848.202009038

Video：

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Objective To summarize the clinical data and efficacy of surgical treatment of aortic periannular abscess.Methods The clinical data of 35 aortic periannular abscess patients admitted to our hospital from January 2009 to June 2019 were retrospectively analyzed, including 21 males and 14 females, aged 36 to 67 (53.0±12.3) years. Among them, there were 14 patients of native aortic valve endocarditis and 21 patients of prosthetic valve endocarditis (16 patients of mechanical valve and 5 patients of biological valve). Preoperative blood cultures were positive in 15 patients, including 8 patients of Staphylococcus aureus, 2 patients of Staphylococcus epidermidis, 3 patients of Streptococcus grass green, 1 patient of Pseudomonas aeruginosa, and 1 patient of Enterococcus.Results Eleven patients underwent emergency or urgent surgery. Thirty patients underwent aortic valve replacement, and 5 patients underwent modified Cabrol surgery to replace the aortic root. Early postoperative complications included 1 patient of bleeding, 8 patients of low cardiac output syndrome, 5 patients of renal insufficiency, 10 patients of respiratory insufficiency, 3 patients of tracheotomy, 8 patients of pulmonary infection and 1 patient cerebrovascular accident. The postoperative follow-up period was 6 to 120 (53.6±20.8) months. During the follow-up, 4 patients died and 4 patients were lost. No infection recurred during the follow-up. Perivalval leakage occurred in 3 patients, and one patient underwent occlusion 12 months following the procedure. The survival curve indicated that the 1-year survival rate was 85.5%, and the 5-year survival rate was 67.3%.Conclusion Although the lesions of periannular abscesses are complicated and critical, effective perioperative antibiotic treatment, individualized surgical timing, and appropriate surgical strategies can significantly reduce mortality and achieve better results.

Citation： MA Nan, DING Shiao, MEI Ju, TANG Min, JIANG Zhaolei, ZHANG Yunjiao, ZHANG Li. Surgical treatment for aortic periannular abscess. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 346-349. doi: 10.7507/1007-4848.202009038 Copy

1.	Perrotta S, Lentini S. Surgical management of severe damage of the aortic annulus. Hellenic J Cardiol, 2016, 57(6): 382-388.
2.	Fayad G, Vincentelli A, Leroy G, et al. Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis. J Thorac Cardiovasc Surg, 2014, 147(1): 254-258.
3.	Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis. Eur Heart J, 2015, 36(44): 3075-128.
4.	Cosmi JE1, Tunick PA, Kronzon I. Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr, 2004, 17(7): 766-768.
5.	Bai AD, Steinberg M, Showler A, et al. Diagnostic accuracy of transthoracic echocardiography for infective endocarditis findings using transesophageal echocardiography as the reference standard: A meta-analysis. J Am Soc Echocardiogr, 2017, 30(7): 639-646.
6.	Harding D, Prendergast B. Advanced imaging improves the diagnosis of infective endocarditis. F1000Res, 2018, 7: F1000 Faculty Rev-674.
7.	Aranda-Michel E, Kilic A, Gleason TG, et al. Diagnostic dilemma in prosthetic valve endocarditis: Computed tomography to the rescue. J Card Surg, 2019, 34(4): 208-210.
8.	Denk K, Vahl CF. Infective endocarditis: Considerations regarding optimal timing for surgical treatment. Herz, 2009, 34(3): 198-205.
9.	Spiliopoulos K, Haschemi A, Fink G, et al. Infective endocarditis complicated by paravalvular abscess: A surgical challenge. An 11-year single center experience. Heart Surg Forum, 2010, 13(2): E67-E73.
10.	Kirali K, Sarikaya S, Ozen Y, et al. Surgery for aortic root abscess: A 15-year experience. Tex Heart Inst J, 2016, 43(1): 20-28.
11.	Baumgartner FJ, Omari BO, Robertson JM, et al. Annular abscesses in surgical endocarditis: Anatomic, clinical, and operative features. Ann Thorac Surg, 2000, 70(2): 442-447.
12.	Nottin R, Al-Attar N, Ramadan R, et al. Aortic valve translocation for severe prosthetic valve endocarditis: Early results and long-term follow-up. Ann Thorac Surg, 2005, 79(5): 1486-1490.

1. Perrotta S, Lentini S. Surgical management of severe damage of the aortic annulus. Hellenic J Cardiol, 2016, 57(6): 382-388.
2. Fayad G, Vincentelli A, Leroy G, et al. Impact of antimicrobial therapy on prognosis of patients requiring valve surgery during active infective endocarditis. J Thorac Cardiovasc Surg, 2014, 147(1): 254-258.
3. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis. Eur Heart J, 2015, 36(44): 3075-128.
4. Cosmi JE1, Tunick PA, Kronzon I. Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography. J Am Soc Echocardiogr, 2004, 17(7): 766-768.
5. Bai AD, Steinberg M, Showler A, et al. Diagnostic accuracy of transthoracic echocardiography for infective endocarditis findings using transesophageal echocardiography as the reference standard: A meta-analysis. J Am Soc Echocardiogr, 2017, 30(7): 639-646.
6. Harding D, Prendergast B. Advanced imaging improves the diagnosis of infective endocarditis. F1000Res, 2018, 7: F1000 Faculty Rev-674.
7. Aranda-Michel E, Kilic A, Gleason TG, et al. Diagnostic dilemma in prosthetic valve endocarditis: Computed tomography to the rescue. J Card Surg, 2019, 34(4): 208-210.
8. Denk K, Vahl CF. Infective endocarditis: Considerations regarding optimal timing for surgical treatment. Herz, 2009, 34(3): 198-205.
9. Spiliopoulos K, Haschemi A, Fink G, et al. Infective endocarditis complicated by paravalvular abscess: A surgical challenge. An 11-year single center experience. Heart Surg Forum, 2010, 13(2): E67-E73.
10. Kirali K, Sarikaya S, Ozen Y, et al. Surgery for aortic root abscess: A 15-year experience. Tex Heart Inst J, 2016, 43(1): 20-28.
11. Baumgartner FJ, Omari BO, Robertson JM, et al. Annular abscesses in surgical endocarditis: Anatomic, clinical, and operative features. Ann Thorac Surg, 2000, 70(2): 442-447.
12. Nottin R, Al-Attar N, Ramadan R, et al. Aortic valve translocation for severe prosthetic valve endocarditis: Early results and long-term follow-up. Ann Thorac Surg, 2005, 79(5): 1486-1490.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment for aortic periannular abscess

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