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\begin{document}

\title{Surgical outcomes and optimal approach to treatment of aortic valve
endocarditis with aortic root abscess -- systematic review and
meta-analysis}



\author[1]{William Harris M}%
\author[1]{Shubhra Sinha}%
\author[1]{Massimo Caputo}%
\author[1]{Gianni Angelini}%
\author[1]{Hunaid Vohra A}%
\affil[1]{University of Bristol}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\begin{abstract}
\textbf{Background} Data on the postoperative outcomes for patients with
infective endocarditis complicated by an aortic root abscess is sparse
due to the condition's low incidence and high mortality rates. This
systematic review and meta-analysis aims to evaluate existing data on
the impact of aortic root abscesses (ARA) on the postoperative outcomes
of surgically managed infective endocarditis (IE) and to inform optimal
surgical approach. \textbf{Methods} The online databases MEDLINE, EMBASE
and Cochrane library were searched from 1990 to 2022 for studies
comparing ARA with NARA (no ARA) in infective endocarditis. Data was
extracted by two independent investigators and aggregated in a
random-effects model (Review Manager version 5.3). Risk of bias was
assessed using an adapted version of the Newcastle-Ottawa scale.
\textbf{Results} Six clinical studies were included in the meta-analysis
(n = 1982). The ARA group was associated with an increased risk of
in-hospital mortality (OR = 1.74 96\% CI 1.18-2.56) and late mortality
(HR = 1.27 95\% CI 1.03-1.58). The reoperation meta-analysis was
complicated by high rates of heterogeneity (I \textsuperscript{2} =
59\%) and found no significant differences in reoperation between group
ARA and NARA (no ARA) (HR = 1.48; 95\% CI 0.92-2.40). Post-hoc scatter
graph showed a strong linear relationship (r=0.998), suggesting
hospitals with higher rates of aortic root replacement (ARR) achieve
lower rates of reoperation for ARA patients compared with PR.
\textbf{Conclusions} The presence of an ARA in aortic valve endocarditis
is associated with elevated early and late mortality despite modern
standards of care. Additionally, ARR should be considered to have a
favourable postoperative profile for use in this context.%
\end{abstract}%



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