Abstract
Objectives Treatment of destructive endocarditis with abscess formation is a surgical challenge
and associated with significant morbidity and mortality. A root replacement is often
performed in case of an annular abscess. This retrospective study was designed to
assess the long-term outcome of extensive debridement and patch reconstruction as
an alternative approach.
Methods Between November 2007 and November 2016, a selected group of 79 patients (29.6% of
all surgical endocarditis cases) with native valve endocarditis (NVE, 53.2%) or prosthetic
valve endocarditis (PVE, 46.8%) valve endocarditis underwent surgical therapy with
extensive annular debridement and patch reconstruction. Their postoperative course,
freedom from recurrent endocarditis, and survival at 1, 5, and 7 years were evaluated.
Results About two-thirds of patients were in a stable condition, one-third of patients were
in a critical state. The median logistic EuroSCORE I was 17%. Infected tissue was
removed, and defect closure was performed, either with autologous pericardium for
small defects, or with bovine pericardium for larger defects. Overall, in-hospital
mortality was 11.3% (NVE: 9.7%, PVE: 13.2%; p = 0.412). In single valve endocarditis survival at 1, 5, and 7 years was 81, 72,
72%, respectively for NVE, and 80, 57, 57%, respectively for PVE (p = 0.589), whereas in multiple valve endocarditis survival at 1, 5, and 7 years was
82, 82, 82% for NVE, and 61, 61, and 31%, respectively for PVE (p = 0.132). Confirmed late reinfection was very low.
Conclusion Surgical treatment of destructive endocarditis with abscess formation using patch
repair techniques offers acceptable early and long-term results. The relapse rate
was low. PVE and involvement of multiple valves were associated with worse outcomes.
Keywords
endocarditis - patch repair - survival - recurrence
