F. Jault et al., PROSTHETIC VALVE ENDOCARDITIS WITH RING ABSCESSES - SURGICAL-MANAGEMENT AND LONG-TERM RESULTS, Journal of thoracic and cardiovascular surgery, 105(6), 1993, pp. 1106-1113
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.