6 Simple or complex surgery in infective endocarditis complicated by abscess: what is the need and what are the outcomes?

Abstract

the medically treated had higher mean creatinine values (132mmol/L, p<0.01) and compared to the SAVR patients were older (89.0 years, p<0.01) with more previous cardiac surgery (13%, p<0.01). They also had less documented coronary disease (33%, p<0.01) (but did not undergo routine angiography).All TAVI patients had surgical access (86% trans-femoral, 8% trans-apical, 6% direct aortic), an Edwards (XT or Sapien 3) valve and general anaesthetic in 69% of cases. There were no intraoperative deaths but 3 conversions to sternotomy for bleeding. 68% of the surgical patients underwent isolated AVR and 32% AVR+CABG with 1 surgical intraoperative death.Medically managed patients had poor outcomes with a mortality of 49% at 1 year and 77% at 3 years. Survival of patients with either intervention was better, with no significant difference in 30-day mortality of SAVR and TAVI (5.3% vs 2.3%, p=049) or 3-year mortality (33% vs. 36%, p=0.66) respectively (figure 1). Compared with TAVI, SAVR patients spent significantly more days on ITU/HDU (8.31±12 vs. 0.96 ±1.7, p<0.01) and in hospital (21.69±24 vs. 11.89 ±9.9, p<0.01). SAVR patients had more pulmonary complications than TAVI (26% vs. 11%, p=0.02.) 17% of the SAVR and all the TAVI pulmonary complications were chest infections but SAVR patients also required 19 chest drains insertions and 6 reintubations. There were no significant differences in the other outcomes (table 2). Finally, whilst acute kidney injury (AKI) rates were statistically similar, all but 1% of the TAVR patients resolved spontaneously where as 13% of the SAVR patients required renal replacement therapy p<0.01. Conclusion The prognosis of patients >85 years of age with symptomatic severe aortic stenosis without intervention is poor. Aortic valve intervention in very elderly patients has acceptable mortality out to 3 years. In our early experience, using surgical access and high rates of general anaesthesia, TAVI in this group had similar mortality to SAVR but with significant reductions in both ITU and overall hospital stay.