Analyzing the Long-term Outcomes of Aortic Root Abscess in Infective Endocarditis

Objective: The mortality rate of invasive infective endocarditis (IE) with extensive destruction of aortic root is high at present. This study aims to describe the long-term outcomes of aortic root abscess. Methods: Of the 244 cases of IE performed between October 1999 and August 2019 at our hospital, 38 cases (15.6%) where the infection had extended to the aortic root were included in our study. The mean patient age was 58.9±14.2 (24-81 years) years and 32 patients were male (89%). Out of the 38 IE cases, 7 cases affected the congenital bicuspid valves, 1 case involved the monocuspid valve, and 21 cases involved prosthetic valves (55.3%, 14 cases of biological valves and 7 cases of mechanical valves). The mean duration of follow-up was 4.9 ± 5.1 years. Results: Preoperatively, 5 cases (13.2%) resulted in hemodynamic shock, cerebral infarction was observed in 12 cases (31.6%), intubation was required in 7 cases (18.4%), and emergency surgery was required in 22 cases (57.9%). There were 7 in-hospital deaths (18.4%), 1 wide cerebral infarction, 1 occurrence of hypocardiac syndrome, 1 case of bleeding from the splenic artery, 3 sepsis patients, 3 cases with perforations of the sigmoid colon, and 6 of 7 cases with prosthetic-valve IE. The overall survival rates at 1 year and 5 years were 77.2% and 64.0%, respectively. Prosthetic-valve IE was found to be a risk factor for early mortality but not for late mortality (p=0.014 early, p=0.150 late). Freedom from recurrent IE at 1 year and 5 years postoperatively was 92.4% and 82.7%, respectively. Atopic dermatitis was also found to be a risk factor (p=0.0017). Conclusions: The surgical outcome for aortic root abscess was acceptable. The prognosis of IE arising from prosthetic valves was poor. Further, atopic dermatitis was found to be a risk factor for re-infection. KEYWORD: e-PD-37 The authors do not declare any conflict of interest.