Perioperative characteristics in patients with infective endocarditis complicated by intracardiac abscesses

Abstract

The aim – to present the outcomes of surgical interventions for intracardiac abscesses resulting from infective endocarditis of various localizations.
Materials and methods. We retrospectively analyzed 552 patients with intracardiac abscesses complicating infective endocarditis, treated between September 2000 and August 2023. This cohort represented 10.8 % of all patients diagnosed with infective endocarditis during that period. The entire cohort was categorized into four subgroups based on abscess localization, with an additional group representing cases with abscess fistulization (aortic root abscess (ARA), mitral valve abscess (MVA), aortic root & mitral valve abscess (AMA), fistula (F)). All patients underwent cardiac surgery with intracardiac reconstruction. 
Results and discussion. The mean age of patients within the general cohort was 44.1 ± 0.6 years, with males comprising 464 (84.0 %) of the population. Pathogenic organisms were identified in 272 patients (49.3 %), of whom Staphylococcus spp. predominated in 157 cases (57.9 %), and Enterococcus spp. constituted 57 cases (21.0 %). Surgical complexity varied significantly among groups. The shortest aortic clamping duration was observed in the MVA group (115.1±4.1 minutes), while the longest duration was recorded in the F group (157.9±7.2 minutes). The duration of cardiopulmonary bypass exhibited the highest values in the F group (236.9±11.1 min), indicative of increased surgical complexity within this cohort. Prolonged artificial ventilation of the lungs was noted in AMA patients (25.07±2.6 h). Surgical methods employed for intracardiac abscesses illustrated various strategies for cardiac structure restoration. Aortic valve replacement emerged as the primary procedure: 95.6 % (ARA group), 96 % (AMA group), and 95 % (F group). Valve reconstruction was infrequent, occurring in merely 5 % of cases. Autopericardial patches were used in 95.6 % (ARA group) and 100 % (F group) for the repair of fibrous rings and cardiac walls. Mitral valve reconstruction surgeries were predominant in the MVA group (58.8 %), reflecting a preference for valve-preserving techniques. However, a higher incidence of valve replacement was observed in the AMA and F groups (up to 30.7 %), attributed to extensive tissue damage. The in-hospital mortality rate within the initial 30 days postsurgery was 2.3 %, with the AMA group exhibiting the highest mortality (2.6 %) and the ARA group the lowest (1.8 %).
Conclusions. The surgical treatment strategies for intracardiac abscesses in patients with infective endocarditis constitute a complex yet critical component of cardiac surgery. The 23-year experience in surgical interventions has led to a low hospital mortality rate of 2.3 %. The application of autopericardial patches offers significant advantages, including isolation of infected regions from the systemic circulation, anticipated bacterial resistance, and requisite patch strength. The implementation of mitral valve reconstruction techniques in infective endocarditis patients with intracardiac abscesses have yielded favorable outcomes. Reoperative challenges in such patients persist, alongside increased risks of postoperative complications and in-hospital mortality. Autopericardium emerges as a fundamental component in the surgical reconstruction of intracardiac structures, providing a dependable and versatile approach to the management of intracardiac abscesses, effectively addressing immediate abscess resolution and fostering long-term structural integrity and functional restoration.