Comparison of long term outcome in patients with or without aortic ring abscess treated surgically for aortic valve infective endocarditis

Objective-To assess the long term prognostic significance of aortic valve r ing abscess in patients with aortic endocarditis. Patients-A consecutive series of 75 patients who had surgery for aortic inf ective endocarditis between 1981 and 1989; 35 had aortic ring abscesses (gr oup 1) and 40 did not (group 2). Mean age did not differ between the two gr oups. Prosthetic valve endocarditis was present in 17% of group 1 and 5% of group 2. Pneumococcal or beta haemolytic streptococcal endocarditis was mo re common in patients with native valve endocarditis who had aortic ring ab scesses (20% v 5%). Design-Cohort analysis. Results-In-hospital mortality (11.4% v 7.5%) and 10 year survival (56% v 66 %) were not significantly different between groups 1 and 2. In patients wit h native valve endocarditis, 10 year survival was 62% and 66%, respectively for patients with or without ring abscess, and 10 year reintervention-free survival was 38% v 58% (p = 0.11). In these patients, the presence of an i ntercurrent illness, severe congestive heart failure before surgery, and us e of valved conduits for surgical treatment were predictors of poorer long term survival, At follow up residual aortic regurgitation was documented in 72% of patients in group 1 and 26% in group 2 (p < 0.01). Conclusions-Aortic valve ring abscess is not an independent marker of poor long term outcome in patients with infective endocarditis. However, as resi dual aortic regurgitation appears frequent at follow up, specific surgical techniques should be considered in patients with paravalvar abscesses.