Perivalvular abscesses associated with endocarditis - Clinical features and prognostic factors of overall survival in a series of 233 cases

Aims The purposes of this study were to determine the clinical features and to identify prognostic factors of abscesses associated with infective endo carditis. Methods and Results During a 5-year period from January 1989, 233 patients with perivalvular abscesses associated with infective endocarditis were enr olled in a retrospective multicentre study. Of the patients, 213 received m edical-surgical therapy and 20 medical therapy alone. No causative microorg anism could be identified in 31% of cases. Sensitivity for the detection of abscesses was 36 and 80%. respectively using transthoracic and transoesoph ageal echocardiography. Surgical treatment consisted of primary suture of t he abscess (38%), insertion of a felt aortic or mitral ring using Teflon or pericardium (42%), or debridment of the abscess cavity (20%). The 1 month operative mortality was 16%. Actuarial rates for overall survival at 3 and 27 months in operated patients were 75 +/- 10% and 59 +/- 11%, respectively . Increasing patient age, staphylococcal infection, and fistulization of th e abscess were found to be independent risk factors in both 1 month and ove rall operative mortality. Renal failure was a risk factor predictive of ope rative mortality at 1 month, whereas uncontrolled infection and circumferen tial abscess were regarded as risk factors predictive of overall operative mortality. Conclusion The data determined prognostic factors of abscesses associated w ith infective endocarditis.