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Surgical Treatment of Valvular Infective Endocarditis Complicated by An Abscess: A Single Center’s Experience

Marco Picichè, Federico Ranocchi, Brenno Fiorani, Marcello Bergonzini, Mariano Feccia, Andrea Montalto, Cesare D' Alessandro, Marzia Cottini, Riccardo Gherli, Bruno Mariani, Gabriella Parisi, Giovanni Casali, Gianpaolo Luzi, Amedeo Pergolini, Emilio Ferretti, Fiorella Giacopino, Saverio Leonardi Cattolica, Lino Madaro and Francesco Musumeci

Objectives: To examine the surgical treatment and mortality rate of valvular infective endocarditis complicated by an abscess in patients at a major tertiary care center.

Background: Infective endocarditis (IE) involving a heart valve is fatal if left untreated. The appearance of a comorbid abscess impacts the choice of treatment and surgical technique and, in some instances, may present unique technical challenges.

Methods: Departmental data from all patients who underwent surgery for IE at a single major tertiary care center from July 2007 to January 2016 were retrospectively screened for the presence of an intracardiac abscess. Patients with at least one confirmed abscess were examined further with respect to the surgical procedures completed and 30-day mortality rate.

Results: Over the almost nine years of data collection, we identified 14 patients (9 males, 5 females) with at least one confirmed cardiac abscess. Patients ranged in age from 28 to 77 years old (mean 57.8 ± 14 years). Various surgical procedures were performed, including aortic or/and mitral valve replacement, mitral or/and tricuspid valve repair, and a freestyle prosthetic valve implant in the pulmonary position. In two patients, surgery was extended to include the ascending aorta; while two patients underwent coronary artery bypass grafting. A patch technique was adopted whenever necessary. Overall, 12 patients survived, while one died from septic shock and another from pneumonia.

Conclusions: An abscess is a serious complication of valvular infective endocarditis that can appreciably increase the complexity of surgical intervention. In our experience, however, this seemed not to directly affect the 30-day mortality-rate, with both deaths ascribed to disseminated infection.