Aagaard J, Andersen P V
Department of Cardio-Thoracic and Vascular Surgery, Odense University Hospital, Denmark.
Ann Thorac Surg. 2001 Jan;71(1):100-3; discussion 104. doi: 10.1016/s0003-4975(00)02334-1.
Operation for active infective endocarditis carries high mortality and morbidity rates, especially when the annulus is involved. Overall the literature favors the use of autograft and homograft valves because of better resistance to infection. In our clinic during the last 5 years we used an aggressive surgical approach to infective endocarditis in combination with implantation of mechanical or stented bioprosthetic devices.
From 1994 to 1999, 50 adults with aortic and/or mitral valve endocarditis underwent valve replacement. The median age of the 36 men and 14 women was 58 years (range, 17 to 78 years). All patients had active endocarditis at the time of operation. Native valve endocarditis was present in 48 patients and prosthetic valve endocarditis was present in 2 patients. The aortic valve was affected in 24 patients, the mitral valve in 21 patients, and both the aortic and mitral valves in 5 patients. Two of the patients with mitral endocarditis also had infection of the tricuspid valve. Annular destruction was present in 24 patients (48%). The patients were treated with radical excision of all infected tissue. The annular defects were closed, if possible, with direct sutures. Otherwise, a reconstruction was performed. Follow-up was 100% complete with a median follow-up period of 45 months (range, 6 to 66 months).
The procedures were performed without lethal bleeding complications. Early mortality was 12% and the actuarial survival at follow-up was 80%. In none of the patients who died was death related to the prosthetic valve or recurrence of the endocarditis. Only 1 patient (2%) developed recurrence of the infective endocarditis and was reoperated with a Ross procedure. Three and a half years later the patient developed severe valve insufficiency of the autograft and was operated again with implantation of a mechanical device.
Native and prosthetic valve endocarditis can be treated successfully with aggressive surgical debridement and implantation of mechanical or stented bioprosthetic devices with a low risk of recurrent endocarditis.
活动性感染性心内膜炎的手术死亡率和发病率较高，尤其是当瓣环受累时。总体而言，由于对感染的抵抗力更强，文献支持使用自体瓣膜和同种异体瓣膜。在过去5年中，我们诊所采用积极的手术方法治疗感染性心内膜炎，并结合植入机械瓣膜或带支架的生物假体装置。
1994年至1999年，50例患有主动脉瓣和/或二尖瓣心内膜炎的成人接受了瓣膜置换术。36名男性和14名女性的年龄中位数为58岁（范围17至78岁）。所有患者在手术时均患有活动性心内膜炎。48例为原发性瓣膜心内膜炎，2例为人工瓣膜心内膜炎。24例患者主动脉瓣受累，21例患者二尖瓣受累，5例患者主动脉瓣和二尖瓣均受累。2例二尖瓣心内膜炎患者还伴有三尖瓣感染。24例患者（48%）存在瓣环破坏。患者接受了所有感染组织的根治性切除。如果可能，瓣环缺损用直接缝合关闭。否则，进行重建。随访率为100%，随访期中位数为45个月（范围6至66个月）。
手术过程中未出现致命性出血并发症。早期死亡率为12%，随访时的精算生存率为80%。死亡患者中无一例死亡与人工瓣膜或心内膜炎复发有关。只有1例患者（2%）发生感染性心内膜炎复发，并接受了罗斯手术再次手术。三年半后，该患者自体瓣膜出现严重瓣膜功能不全，并再次接受手术植入机械装置。
原发性和人工瓣膜心内膜炎可通过积极的手术清创和植入机械瓣膜或带支架的生物假体装置成功治疗，复发性心内膜炎风险较低。
