{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:00:34Z","timestamp":1787029234310,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,6,23]],"date-time":"2025-06-23T00:00:00Z","timestamp":1750636800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Background: Aortic valve infective endocarditis (IE) complicated by an aortic root abscess is a challenging problem that leads to increased morbidity and mortality. Aortic root repair or replacement are two potential treatment options. We aimed to compare patients undergoing aortic root repair or replacement with short- and mid-term outcomes. Methods: Consecutive patients with active aortic valve IE complicated by aortic root abscess undergoing cardiac surgery from January 2012 to January 2022 were included. Patients receiving aortic root repair were compared to patients undergoing aortic root replacement. Endpoints included overall mortality, incidence of recurrent IE and re-intervention during a two-year follow-up period. Inverse propensity weighting was employed to adjust for confounders. Results: Seventy-three patients with aortic valve IE with root abscess underwent surgical therapy. Fifty-six patients received aortic root repair and seventeen patients underwent aortic root replacement. Patients undergoing root replacement had significantly higher surgical risk (EuroSCORE II: 9 versus 19, p = 0.02) and extended disease (circumferential annular abscess: 9% versus 41%, p &lt; 0.01). Inverse propensity weighted analysis revealed no relationship between surgical strategy and outcome. Weighted regression analysis revealed EuroSCORE II and disease extension as significant predictors of 30-day and 2-year mortality. Conclusions: In patients with aortic valve IE with root abscess, root repair is mostly performed in lower-risk patients with limited disease extension. Short- and mid-term mortality, recurrent endocarditis and reintervention were comparable between surgical strategies during follow-up. Surgical risk and disease extension, rather than surgical strategy, seem to be significant predictors of short- and mid-term mortality.<\/jats:p>","DOI":"10.3390\/pathogens14070626","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T06:49:38Z","timestamp":1750747778000},"page":"626","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Aortic Valve Infective Endocarditis with Root Abscess: Root Repair Versus Root Replacement"],"prefix":"10.3390","volume":"14","author":[{"given":"Zaki","family":"Haidari","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, 55 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Knipp","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, 55 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iskandar","family":"Turaev","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, 55 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"El Gabry","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, 55 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3222","DOI":"10.1093\/eurheartj\/ehz620","article-title":"Clinical presentation, aetiology and outcome of infective endocarditis. Results of the ESC-EORP EURO-ENDO (European infective endocarditis) registry: A prospective cohort study","volume":"40","author":"Habib","year":"2019","journal-title":"Eur. Heart J."},{"key":"ref_2","first-page":"262","article-title":"Surgical management of aortic root abscess","volume":"12","author":"David","year":"1997","journal-title":"J. Card. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ejcts.2006.10.036","article-title":"Surgical treatment of paravalvular abscess: Long-term results","volume":"31","author":"David","year":"2007","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1093\/ejcts\/ezv138","article-title":"Early and late outcomes of complex aortic root surgery in patients with aortic root abscesses","volume":"49","author":"Leontyev","year":"2016","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/S0022-5223(94)70466-X","article-title":"Surgical treatment of active infective endocarditis with paravalvular involvement","volume":"107","author":"Watanabe","year":"1994","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1136\/hrt.81.2.177","article-title":"Comparison of long term outcome in patients with or without aortic ring abscess treated surgically for aortic valve infective endocarditis","volume":"81","author":"Danchin","year":"1999","journal-title":"Heart"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.amjcard.2004.03.047","article-title":"Comparison of outcomes in patients with active infective endocarditis with versus without paravalvular abscess and with and without valve replacement","volume":"94","author":"Langiulli","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_8","first-page":"801","article-title":"Clinical features and outcome of non-drug-addicted patients with infective endocarditis and perivalvular abscess","volume":"14","author":"Castillo","year":"2005","journal-title":"J. Heart Valve Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S0003-4975(00)02334-1","article-title":"Acute endocarditis treated with radical debridement and implantation of mechanical or stented bioprosthetic devices","volume":"71","author":"Aagaard","year":"2001","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1016\/j.jtcvs.2019.12.140","article-title":"Root abscess in the setting of infectious endocarditis: Short- and long-term outcomes","volume":"162","author":"Yang","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/313753","article-title":"Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis","volume":"30","author":"Li","year":"2000","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Giambuzzi, I., Bonalumi, G., Di Mauro, M., Roberto, M., Corona, S., Alamanni, F., and Zanobini, M. (2021). Surgical aortic mitral curtain replacement: Systematic review and metanalysis of early and long-term results. J. Clin. Med., 10.","DOI":"10.3390\/jcm10143163"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.cmi.2020.09.003","article-title":"Factors associated with local invasion in infective endocarditis: A nested case-control study","volume":"27","author":"Ramanathan","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1053\/j.optechstcvs.2016.07.001","article-title":"Reconstruction and Replacement of the Aortic Root in Destructive Endocarditis","volume":"20","author":"Smail","year":"2016","journal-title":"Oper. Tech. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1053\/euhj.1999.1877","article-title":"Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess\u201411 year results","volume":"21","author":"Knosalla","year":"2000","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1016\/S0003-4975(02)03779-7","article-title":"Aortic root replacement with cryopreserved allograft for prosthetic valve endocarditis","volume":"74","author":"Sabik","year":"2002","journal-title":"Ann. Thorac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ejcts.2005.03.017","article-title":"Homograft reconstruction of the aortic root for endocarditis with periannular abscess: A 17-year study","volume":"28","author":"Yankah","year":"2005","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1093\/ejcts\/ezx421","article-title":"Outcome of surgical intervention for aortic root abscess: A meta-analysis","volume":"53","author":"Chen","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1177\/02676591221137484","article-title":"Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess\u2014Systematic review and meta-analysis","volume":"39","author":"Harris","year":"2024","journal-title":"Perfusion"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.1111\/jocs.16464","article-title":"Surgical outcomes and optimal approach to treatment of aortic valve endocarditis with aortic root abscess","volume":"37","author":"Harris","year":"2022","journal-title":"J. Card. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.hlc.2018.05.200","article-title":"Surgery for Active Infective Endocarditis of the Aortic Valve With Infection Extending Beyond the Leaflets","volume":"28","author":"Elgalad","year":"2019","journal-title":"Heart Lung Circ."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Elderia, A., Wallau, A.M., Bennour, W., Gerfer, S., Gaisendrees, C., Krasivskyi, I., Djordjevic, I., Wahlers, T., and Weber, C. (2024). Impact of Aortic Root Abscess on Surgical Outcomes of Infective Endocarditis. Life, 14.","DOI":"10.3390\/life14010092"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1093\/icvts\/ivab330","article-title":"Impact of aortic root repair or replacement in severe destructive aortic valve endocarditis with paravalvular abscesses on long-term survival","volume":"34","author":"Abfalterer","year":"2022","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.athoracsur.2016.02.019","article-title":"Infective Endocarditis with Paravalvular Extension: 35-Year Experience","volume":"102","author":"Revest","year":"2016","journal-title":"Ann. Thorac. Surg."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/7\/626\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:57:22Z","timestamp":1760032642000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/14\/7\/626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,23]]},"references-count":25,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["pathogens14070626"],"URL":"https:\/\/doi.org\/10.3390\/pathogens14070626","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,23]]}}}