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Surgery Recommended for Abscess in Late Infective Endocarditis
CopyFrom: PUMCH UpdateTime: 2018-07-13 Hits: 12 Font Size: SmallBig

A PUMCH multi-disciplinary team centered on Cardiac Surgery operated on 56 cases of aortic root abscess in infective endocarditis (IE) from 2008 to 2017. Good prognosis is reported except two deaths. This won the third prize of Medical Achievements Award of the hospital.

Aortic root abscess is the most serious and fatal complication in IE. The abscess, dubbed a tumor in IE, is a sign of late-stage infection, and doesn’t respond to antibiotics. The abscess will progress rapidly, and may cause death if perforation occurs. Therefore surgery as soon as possible is recommended for such patients.

Such surgery is highly individualized, difficult and risky. A doctor must operate according to the direction and location of the abscess. The aim is to remove the infection completely, prevent recurring of infection and rebuild the heart. It often needs to remove a muscle or valve invaded by the infection, and then repair or replace the valve. In a case of serious infection, the originally strong muscle may become as soft as bean curd, adding difficulty to the operation.

The death rate of such surgery in Europe and America is around 30%. According to a 2009 report by Journal of Thoracic & Cardiovascular Surgery, a three-year research on 172 cases in Germany said the three-day death rate was 25%. In ten years, PUMCH accepted more than 400 cases of IE, including 56 with aortic root abscess. Under the joint efforts of Cardiac Surgery, Anesthesiology, ICU, Cardiology and Infection, only two patients died during hospitalization, the death rate being 3.6%

The success is a result of our hospital’s comprehensive capability for serious and difficult cases, multi-disciplinary team, choice of surgery time and accurate operations. So far, as China’s largest single center for IE, the CMI for our Cardiac Surgery is 4.5, the highest in Beijing, according to the 2015 Assessment Report on Hospitalization Services of Medical Institutions and Key Specialized Hospitals in Beijing published by the Beijing Municipal Commission of Health and Family Planning. The 56 cases included 22 with serious heart failure, 11 with moderate heart failure and nine with a history of heart surgery.

According to Miao Qi, director of Cardiac Surgery, PUMCH, the hospital’s death rate being lower than international reports is partly because that the foreign research featured a longer follow-up time, higher difficulty and more cases. Our hospital is willing to meet the challenge of more and harder cases to benefit Chinese patients.