Surgical management of aortic root abscess.

BACKGROUND

The mortality and morbidity associated with surgery for aortic root abscess is reportedly high. This is a review of our experience with radical resection of the abscess and reconstruction of the left ventricular outflow tract with pericardium.

METHODS

Sixty-three consecutive patients with aortic root abscess were operated on since 1980. Their mean age was 47 years, range 16 to 75; 53 patients were men. Thirty-one patients had native and 32 had prosthetic valve endocarditis; of these 32, 13 had previous composite replacement of the aortic valve and ascending aorta. The most common offending microorganisms were staphylococci, which were cultured in 31 patients. The abscess was confined to the aortic annulus in 22 patients and had extended into surrounding structures in 41. The abscess involved the mitral valve in 13, the tricuspid valve in 2, and the pulmonary valve in 1. Radical resection of the abscess and reconstruction of the left ventricular outflow tract and other valve annull was accomplished with autologous or glutaraldehyde-fixed bovine pericardium. Aortic valve homograft was used in only three patients; prosthetic heart valves in 60.

RESULTS

There were eight deaths; 26 patients experienced one or more non-fatal perioperative complication. Patients were followed up for a mean of 58 +/- 39 months. There were ten late deaths; the actuarial survival at 10 years was 55% +/- 10%. Nine patients developed late recurrent endocarditis 10 to 108 months postoperatively. The freedom from recurrent endocarditis at 10 years was 75% +/- 8%.

CONCLUSIONS

Radical resection of aortic root abscess and reconstruction of the left ventricular outflow tract with pericardium is an effective method to eradicate the infection. These patients appear to have a relatively high risk of recurrent endocarditis.