Surgical treatment of acute endocarditis of the aortic valve with paravalvular abscess: considerations justifying the use of mechanical replacement devices

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Abstract
OBJECTIVE: Early recurrency after surgery for acute endocarditis is alife-threatening complication. Allograft valves are supposed to have ahigher resistance to recurrent infection, thus several authors claim themto be the replacement device of choice in cases of aortic endocarditis.However, allografts have two major drawbacks: their availability islimited, and most of the patients require reoperation for graftcalcification of degeneration. Until now there has been no prospectivestudy analysing whether early recurrency after surgery of acuteendocarditis is associated with the mechanical valve per se or with factorsrelated to the surgical technique or postoperative care. PATIENTS ANDMETHODS: We present a prospective study on 36 consecutive patients withacute endocarditis of the aortic valve with paravalvular abscesses. In thisseries, there were 5 women and 31 men with a mean age of 50.3 years. Allpatients were operated before a course of antibiotic therapy was completed.Abscesses were radically resected and the cavities closed either withdirect suture or, if not possible, with Dacron patches. For aortic valvereplacement, a mechanical valve was used in every patient. RESULTS: Theearly mortality in this series was 14%, only one patient experiencedrecurrent endocarditis and underwent reoperation. The results compare wellwith those achieved after valve replacements with allograft valves.CONCLUSION: We conclude that, even in cases of acute endocarditis,replacement of the aortic valve with a mechanical device is an acceptablealternative to the allograft, if radical surgical debridement and adequateantibiotic therapy are performed.

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