PROSTHETIC VALVE ENDOCARDITIS WITH RING ABSCESSES - SURGICAL-MANAGEMENT AND LONG-TERM RESULTS

From January 1978 to December 1988, 71 patients underwent surgical int ervention at our institution for prosthetic valve endocarditis with ri ng abscesses. These procedures involved 59 aortic prostheses and 12 mi tral prostheses. No causative agent could be identified in 19 patients (26.7 %). The operation was performed during antibiotic therapy in 63 patients and after a planned course of antibiotic therapy in 8 patien ts. At the aortic level, abscesses were remedied by suturing in 3 case s, by pericardial patches in 34 cases, and by complex procedures in 22 cases (subcoronary valved conduit in 11 cases, supracoronary valved c onduit with coronary bypass grafts in 10 cases, apicoaortic valved con duit in 1 case). At the mitral level, ring abscesses were cured in 10 cases by intraatrial implantation of the prosthesis. In one case, the prosthesis was anchored inside the left ventricle; and in one case the valve could be seated on the anulus. The overall operative mortality rate was 17%. Long-term survival was 54% +/- 8% at 6 years. Fifteen (2 6%) of the survivors needed a third valve replacement (four operative deaths); a complex reconstruction was performed in seven patients. Bet ter detection of ring abscesses and earlier surgical intervention befo re annular destruction and hemodynamic failure can improve the operati ve mortality rate for prosthetic valve endocarditis. When it is necess ary, complex reconstruction, in spite of a high mortality rate, seems to eradicate the infectious seat, and the outlook for the patient's co ndition appears good.