自体瓣膜和人工瓣膜心内膜炎瓣膜置换的近期和远期结果
Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis.
作者信息
Delay D, Pellerin M, Carrier M, Marchand R, Auger P, Perrault L P, Hébert Y, Cartier R, Pagé P, Pelletier L C
机构信息
Department of Surgery, Montreal Heart Institute and the University of Montreal, Quebec, Canada.
出版信息
Ann Thorac Surg. 2000 Oct;70(4):1219-23. doi: 10.1016/s0003-4975(00)01887-7.
BACKGROUND
The objective of the present study was to compare current results of prosthetic valve replacement following acute infective native valve endocarditis (NVE) with that of prosthetic valve endocarditis (PVE). Prosthetic valve replacement is often necessary for acute infective endocarditis. Although valve repair and homografts have been associated with excellent outcome, homograft availability and the importance of valvular destruction often dictate prosthetic valve replacement in patients with acute bacterial endocarditis.
METHODS
A retrospective analysis of the experience with prosthetic valve replacement following acute NVE and PVE between 1988 and 1998 was performed at the Montreal Heart Institute.
RESULTS
Seventy-seven patients (57 men and 20 women, mean age 48 +/- 16 years) with acute infective endocarditis underwent valve replacement. Fifty patients had NVE and 27 had PVE. Four patients (8%) with NVE died within 30 days of operation and there were no hospital deaths in patients with PVE. Survival at 1, 5, and 7 years averaged 80% +/- 6%, 76% +/- 6%, and 76% +/- 6% for NVE and 70% +/- 9%, 59% +/- 10%, and 55% +/- 10% for PVE, respectively (p = 0.15). Reoperation-free survival at 1, 5, and 7 years averaged 80% +/- 6%, 76% +/- 6%, and 76% +/- 6% for NVE and 45% +/- 10%, 40% +/- 10%, and 36% +/- 9% for PVE (p = 0.003). Five-year survival for NVE averaged 75% +/- 9% following aortic valve replacement and 79% +/- 9% following mitral valve replacement. Five-year survival for PVE averaged 66% +/- 12% following aortic valve replacement and 43% +/- 19% following mitral valve replacement (p = 0.75). Nine patients underwent reoperation during follow-up: indications were prosthesis infection in 4 patients (3 mitral, 1 aortic), dehiscence of mitral prosthesis in 3, and dehiscence of aortic prosthesis in 2.
CONCLUSIONS
Prosthetic valve replacement for NVE resulted in good long-term patient survival with a minimal risk of reoperation compared with patients who underwent valve replacement for PVE. In patients with PVE, those who needed reoperation had recurrent endocarditis or noninfectious periprosthetic dehiscence.
背景
本研究的目的是比较急性感染性自体瓣膜心内膜炎（NVE）后人工瓣膜置换术与人工瓣膜心内膜炎（PVE）后人工瓣膜置换术的当前结果。急性感染性心内膜炎常常需要进行人工瓣膜置换。虽然瓣膜修复和同种异体瓣膜移植已取得了出色的治疗效果，但同种异体瓣膜的可获得性以及瓣膜破坏的严重性常常决定了急性细菌性心内膜炎患者需进行人工瓣膜置换。
方法
对1988年至1998年间在蒙特利尔心脏研究所进行的急性NVE和PVE后人工瓣膜置换术的经验进行回顾性分析。
结果
77例急性感染性心内膜炎患者（57例男性和20例女性，平均年龄48±16岁）接受了瓣膜置换。50例为NVE，27例为PVE。4例（8%）NVE患者在术后30天内死亡，PVE患者无医院死亡病例。NVE患者1年、5年和7年生存率分别平均为80%±6%、76%±6%和76%±6%，PVE患者分别为70%±9%、59%±10%和55%±10%（p = 0.15）。NVE患者1年、5年和7年无再次手术生存率分别平均为80%±6%、76%±6%和76%±6%，PVE患者分别为45%±10%、40%±10%和36%±9%（p = 0.003）。NVE患者主动脉瓣置换术后5年生存率平均为75%±9%，二尖瓣置换术后为79%±9%。PVE患者主动脉瓣置换术后5年生存率平均为66%±12%，二尖瓣置换术后为43%±19%（p = 0.75）。9例患者在随访期间接受了再次手术：4例（3例二尖瓣、1例主动脉瓣）的再次手术指征为人工瓣膜感染，3例为二尖瓣人工瓣膜裂开，2例为主动脉瓣人工瓣膜裂开。
结论
与接受PVE瓣膜置换的患者相比，NVE人工瓣膜置换术可使患者获得良好的长期生存，再次手术风险最小。在PVE患者中，需要再次手术的患者存在复发性心内膜炎或非感染性人工瓣膜周围裂开。
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