CARDIAC ABSCESS IN INFECTIOUS ENDOCARDITIS - A MULTICENTER STUDY OF 233 CASES

The aim of this retrospective multicenter study was to determine prese nt characteristics of infectious endocarditis complicated by abscess a nd to identifying predictive factors of mortality The files of 233 pat ients with infectious endocarditis complicated by perivalvular abscess es between January 1989 and December 1993 were analysed. Two hundred a nd thirteen patients underwent medico-surgical treatment (175 aortic a nd 38 mitral abscesses) and 20 patients underwent medical treatment al one (17 aortic and 3 mitral abscesses). The abscess was observed on na tive valves in 156 cases and valve prostheses in 77 cases. The causati ve organism was identified in 69 % of cases : the commonest organism w as the staphylococcus. The diagnostic sensitivity of transthoracic and transoesophageal echocardiography was 36 and 80 % respectively. The o perative mortality at one month was 16 %. Patients over 65 years of ag e, staphylococcal infection, renal failure and fistulisation of the ab scess, were identified as independant predictive factors of mortality at one month. The survival rate three months after surgery was 75 +/- 10 % and 59 +/- 11 % at 27 months. An age over 65, staphylococcal infe ction, uncontrolled infection, circumferential abscess and fistulisati on were independant predictive factors of global mortality (the first month and after). The mortality rate in unoperated patients was 40 % : cardiac failure and fistulisation of the abscess detected by echocard iography were predictive factors of mortality on univariate analysis.