Impact of aortic root abscess on outcomes in infective endocarditis and predictors of in-hospital mortality: A meta-analysis.

BACKGROUND

Aortic root abscess (ARA) is a severe and life-threatening complication of infective endocarditis (IE), often requiring urgent surgical intervention. However, data on surgical outcomes and predictors of mortality in this population are limited.

OBJECTIVES

We conducted a systematic review and meta-analysis to evaluate postoperative outcomes and identify predictors of in-hospital mortality in patients with IE complicated by ARA.

METHODS

A comprehensive search of PubMed, Web of Science, Scopus, and Embase was performed through February 2025 for studies comparing surgical outcomes in patients with IE with versus without ARA. Risk ratios (RR) were used for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95 % confidence intervals (CI).

RESULTS

Eight observational studies comprising 2266 patients (637 with ARA, 1629 without ARA) were included. ARA was significantly associated with higher in-hospital mortality (15.7 % vs. 12.8 %; RR 1.65, 95 % CI 1.28-2.13, P = 0.0001), late mortality (21.4 % vs. 20.2 %; RR 1.44, 95 % CI 1.16-1.79, P = 0.001), and IE recurrence (10.6 % vs. 4.8 %; RR 2.15, 95 % CI 1.29-3.59, P = 0.003). No significant difference in heart failure incidence was found (RR 1.02, 95 % CI 0.86-1.21, P = 0.82). Renal failure (OR 3.22, 95 % CI 1.37-7.60) and Staphylococcus aureus infection (OR 3.30, 95 % CI 1.50-7.26) were independently associated with higher in-hospital mortality.

CONCLUSIONS

ARA in patients undergoing surgery for IE is associated with worse outcomes, including higher in-hospital and late mortality and greater IE recurrence. Renal failure and S. aureus infection are significant mortality predictors.