Silzone涂层圣犹达医疗瓣膜用于急性感染性心内膜炎的初步经验。

Bertrand S, Houel R, Vermes E, Soustelle C, Hillion M L, Loisance D

Department of Thoracic and Cardiovascular Surgery, CNRS and Association Claude Bernard, CHU Henri Mondor, Creteil, France.

J Heart Valve Dis. 2000 Jan;9(1):131-4.

BACKGROUND AND AIM OF THE STUDY

The rate of recurrent postoperative endocarditis after valve replacement in early-stage acute infective endocarditis is extremely high. Metallic silver coating of the sewing ring may improve the short- and long-term outcome after valve implantation. This report details our experience with the St. Jude Medical Silzone prosthesis in early surgical treatment of acute infective endocarditis.

METHODS

Ten patients (mean age 66.4 years) referred for native valve or prosthetic valve endocarditis were operated on between April 1998 and June 1999. The microorganisms responsible for the acute infection were Staphylococcus (n = 1), Streptococcus (n = 1) and Pseudomonas aeruginosa (n = 1); blood cultures remained negative in two cases. The indication for surgical treatment was related to hemodynamic condition (n = 5), a major cerebral event (stroke; n = 1), annulus abscess (n = 1), and echocardiographic evidence of large cuspal vegetations (n = 3). All patients had received preoperative intravenous antibiotics (mean 7.8 days). Four mitral, five aortic valve replacements, and one double mitral-aortic valve replacement, were performed after extensive debridement of the infected and necrotic tissues. Mean duration of postoperative antibiotic treatment was 32.3 days. Postoperative follow up (mean 6 months; range: 2-14.2 months) was 100% complete, and included prospective repeated transthoracic echocardiography at one week, and one, six and 12 months postoperatively.

RESULTS

One patient died early in the immediate postoperative period from pneumonia and major hypoxemia. All other patients are symptom-free, without evidence of recurrent infection and perivalvular leak.

CONCLUSION

Although these early results with the St. Jude Medical Silzone prosthesis require confirmation by more extensive studies, they infer that silver coating of the sewing ring may dramatically improve management of patients with active endocarditis.

研究背景与目的

早期急性感染性心内膜炎患者瓣膜置换术后的心内膜炎复发率极高。缝合环的金属银涂层可能会改善瓣膜植入后的短期和长期疗效。本报告详细介绍了我们使用圣犹达医疗Silzone人工瓣膜早期手术治疗急性感染性心内膜炎的经验。

方法

1998年4月至1999年6月期间，对10例（平均年龄66.4岁）因天然瓣膜或人工瓣膜心内膜炎前来就诊的患者进行了手术。引起急性感染的微生物有葡萄球菌（n = 1）、链球菌（n = 1）和铜绿假单胞菌（n = 1）；2例血培养结果为阴性。手术治疗的指征与血流动力学状况有关（n = 5）、重大脑部事件（中风；n = 1）、瓣环脓肿（n = 1）以及超声心动图显示有大的瓣叶赘生物（n = 3）。所有患者术前均接受了静脉抗生素治疗（平均7.8天）。在对感染和坏死组织进行广泛清创后，进行了4例二尖瓣置换、5例主动脉瓣置换和1例二尖瓣 - 主动脉瓣联合置换。术后抗生素治疗的平均持续时间为32.3天。术后随访（平均6个月；范围：2 - 14.2个月）完成率为100%，包括术后1周、1个月、6个月和12个月进行的前瞻性重复经胸超声心动图检查。