OUTCOME OF AORTIC-VALVE ENDOCARDITIS WITH AND WITHOUT ANNULAR ABSCESS

Annular abscess is a not uncommon but serious complication of aortic v alve endocarditis. The aim of this retrospective study was to evaluate the prognosis of aortic valve endocarditis with and without annular a bscess. Between January 1981 and 1989, 122 consecutive cases of aortic endocarditis fulfilling the diagnostic criteria of Duke University we re admitted to hospital. Group I included 40 cases with aortic ring ab scess confirmed at surgery, in 35 patients; group II comprised 43 case s of operated aortic valve endocarditis without annular abscess in 41 patients and group III comprised 38 cases of aortic valve endocarditis treated medically without echocardiographic or angiographic signs of annular abscess in 36 patients. The patients in group III were signifi cantly older than those in group I (57 +/- 14 years vs 44 +/- 17 years ; p < 0.001). From the clinical point of view, endocarditis of prosthe tic valves was slightly more common, but without reaching statistical significance: in group I, but the abscess was associated with more sev ere cardiac failure. Systemic embolism, atrioventricular block and per icardial effusion were equally common in the three groups. On the othe r hand, endocarditis with annular abscess was more often the result of infection with streptococci A, B, C or pneumoniae, than forms without abscess (22.5 % vs 5 % and 3 % respectively in the, 3 groups; p < 0.0 5). Of the patients treated surgically, destructive lesions of the val ves were more common in cases of abscess (57.5 % vs 35 %; p < 0.05) : the hospital mortality was higher in cases of abscess (17.5 % vs 7 %). In the long-term, the probability of survival at 6 years (Kaplan-Meie r) was comparable in the three groups. In contrast, the probability of survival without reoperation and the probability of survival without reoperation and without recurrence were higher in patients operated fo r aortic endocarditis without abscess.