Lytle Bruce W, Sabik Joseph F, Blackstone Eugene H, Svensson Lars G, Pettersson Gosta B, Cosgrove Delos M
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA.
Ann Thorac Surg. 2002 Nov;74(5):S1754-7; discussion S1792-9. doi: 10.1016/s0003-4975(02)04129-2.
Prosthetic aortic valve endocarditis (PVE) is an important complication of aortic valve replacement (AVR) and is a particularly difficult situation after an operation combining AVR with ascending aortic replacement.
From 1988 through 2000, 27 patients with aortic valve PVE after previous ascending aortic replacement (aortic root replacement in 13, aortic valve replacement with a supracoronary graft in 14) underwent reoperation for aortic root replacement with a cryopreserved aortic allograft and prolonged intravenous antibiotic therapy. All patients were considered to have active PVE (25 with positive cultures); root abscess formation was present in 89% and aortoventricular discontinuity in 41%.
One patient (3.7%) died in-hospital, and permanent pacemakers were required in 10 patients (37%). Mean postoperative follow-up interval was 3.9 +/- 3.0 years, and survival at 1, 2, 5, and 7.5 years was 92%, 88%, 70%, and 56%, respectively. One patient underwent reoperation for recurrent PVE 8 months after operation.
Radical debridement of infected prosthetic material and tissue, and allograft aortic root and ascending aorta replacement, combined with intravenous antibiotic therapy, appears to achieve a low hospital mortality and a high degree of freedom from recurrent infection for patients with PVE after AVR and ascending aortic replacement.
人工主动脉瓣心内膜炎（PVE）是主动脉瓣置换术（AVR）的一种重要并发症，在AVR与升主动脉置换联合手术后的情况尤为棘手。
1988年至2000年，27例曾接受升主动脉置换术（13例为主动脉根部置换，14例为冠状动脉上移植人工主动脉瓣置换）后发生主动脉瓣PVE的患者接受了再次手术，采用冷冻保存的同种异体主动脉进行主动脉根部置换，并接受了延长的静脉抗生素治疗。所有患者均被认为患有活动性PVE（25例血培养阳性）；89%的患者存在根部脓肿形成，41%的患者存在主动脉心室连续性中断。
1例患者（3.7%）在住院期间死亡，10例患者（37%）需要植入永久性起搏器。术后平均随访时间为3.9±3.0年，1年、2年、5年和7.5年的生存率分别为92%、88%、70%和56%。1例患者术后8个月因复发性PVE接受了再次手术。
对于AVR和升主动脉置换术后发生PVE的患者，彻底清除感染的人工材料和组织，进行同种异体主动脉根部和升主动脉置换，并联合静脉抗生素治疗，似乎可实现较低的医院死亡率和较高的免于反复感染率。
