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Abstract：
OBJECTIVE: Infective endocarditis of the aortic valve complicated by annular abscess is a challenging problem and often requires patch reconstruction after surgical debridement of the abscess cavity. Filling the remaining cavity with antibiotics is advocated to prevent recurrent endocarditis. This study aimed at evaluating the role of local antibiotics in patients with aortic valve infective endocarditis complicated by annular abscess.
METHODS: Between January 2012 and December 2021, all consecutive patients with aortic valve infective endocarditis complicated by annular abscess undergoing cardiac surgery and annular patch reconstruction were included. Patients receiving local antibiotics were compared with patients without local antibiotics. The primary endpoints were the incidence of recurrent endocarditis, re-operation, and mortality during two-year follow-up.
RESULTS: A total of 41 patients with aortic valve infective endocarditis complicated by annular abscess underwent surgical patch reconstruction after radical debridement. In total, 20 patients received local antibiotics in the abscess cavity and 21 patients were treated without local antibiotics. The most common causative microorganisms were the staphylococci species and the most common location of the abscess was the non-coronary annulus. During two-year follow-up, one patient in each group developed recurrent endocarditis (p > 0.99) and both patients were reoperated (p > 0.99). Two-year mortality was 30% in the local antibiotic group and 24% in the control group (p = 0.65).
CONCLUSIONS: Radical debridement and patch reconstruction of the aortic annulus in patients with aortic valve infective endocarditis complicated by annular abscess is an effective surgical strategy. Filling of the remaining abscess cavity with antibiotic seems not to affect the rate of recurrent endocarditis, reoperation, and mortality during two-year follow-up.
METHODS: Between January 2012 and December 2021, all consecutive patients with aortic valve infective endocarditis complicated by annular abscess undergoing cardiac surgery and annular patch reconstruction were included. Patients receiving local antibiotics were compared with patients without local antibiotics. The primary endpoints were the incidence of recurrent endocarditis, re-operation, and mortality during two-year follow-up.
RESULTS: A total of 41 patients with aortic valve infective endocarditis complicated by annular abscess underwent surgical patch reconstruction after radical debridement. In total, 20 patients received local antibiotics in the abscess cavity and 21 patients were treated without local antibiotics. The most common causative microorganisms were the staphylococci species and the most common location of the abscess was the non-coronary annulus. During two-year follow-up, one patient in each group developed recurrent endocarditis (p > 0.99) and both patients were reoperated (p > 0.99). Two-year mortality was 30% in the local antibiotic group and 24% in the control group (p = 0.65).
CONCLUSIONS: Radical debridement and patch reconstruction of the aortic annulus in patients with aortic valve infective endocarditis complicated by annular abscess is an effective surgical strategy. Filling of the remaining abscess cavity with antibiotic seems not to affect the rate of recurrent endocarditis, reoperation, and mortality during two-year follow-up.
摘要：
目的：主动脉瓣感染性心内膜炎并发环状脓肿是一个具有挑战性的问题，通常需要在脓肿腔手术清创后进行补片重建。主张用抗生素填充剩余的腔以防止复发性心内膜炎。本研究旨在评估局部抗生素在主动脉瓣感染性心内膜炎并发环形脓肿患者中的作用。
方法：2012年1月至2021年12月，所有主动脉瓣感染性心内膜炎并发环形脓肿的连续患者均接受心脏手术和环形补片重建。将接受局部抗生素的患者与不使用局部抗生素的患者进行比较。主要终点是复发性心内膜炎的发生率，重新操作,以及两年随访期间的死亡率。
结果：共有41例主动脉瓣感染性心内膜炎并发环形脓肿患者在根治性清创后接受了手术补片重建。总的来说,20例患者在脓肿腔内接受局部抗生素治疗，21例患者不使用局部抗生素治疗。最常见的致病微生物是葡萄球菌，脓肿最常见的位置是非冠状动脉环。在两年的随访中，每组有1例患者出现复发性心内膜炎(p>0.99),2例患者均进行了再次手术(p>0.99).局部抗生素组的两年死亡率为30％，对照组为24％（p=0.65）。
结论：主动脉瓣膜感染性心内膜炎并发环形脓肿患者的主动脉瓣环彻底清创和补片重建是一种有效的手术策略。用抗生素填充剩余的脓肿腔似乎不会影响复发性心内膜炎的发生率。再操作,以及两年随访期间的死亡率。
方法：2012年1月至2021年12月，所有主动脉瓣感染性心内膜炎并发环形脓肿的连续患者均接受心脏手术和环形补片重建。将接受局部抗生素的患者与不使用局部抗生素的患者进行比较。主要终点是复发性心内膜炎的发生率，重新操作,以及两年随访期间的死亡率。
结果：共有41例主动脉瓣感染性心内膜炎并发环形脓肿患者在根治性清创后接受了手术补片重建。总的来说,20例患者在脓肿腔内接受局部抗生素治疗，21例患者不使用局部抗生素治疗。最常见的致病微生物是葡萄球菌，脓肿最常见的位置是非冠状动脉环。在两年的随访中，每组有1例患者出现复发性心内膜炎(p>0.99),2例患者均进行了再次手术(p>0.99).局部抗生素组的两年死亡率为30％，对照组为24％（p=0.65）。
结论：主动脉瓣膜感染性心内膜炎并发环形脓肿患者的主动脉瓣环彻底清创和补片重建是一种有效的手术策略。用抗生素填充剩余的脓肿腔似乎不会影响复发性心内膜炎的发生率。再操作,以及两年随访期间的死亡率。
