Müller Ludwig C, Chevtchik Orest, Bonatti Johannes O, Müller Silvana, Fille Manfred, Laufer Günther
Department of Cardiac Surgery, University of Innsbruck, Innsbruck, Austria.
Ann Thorac Surg. 2003 Feb;75(2):453-6. doi: 10.1016/s0003-4975(02)04062-6.
Successful treatment of destructive aortic valve endocarditis with annular abscess formation requires extensive surgical debridement and reconstruction of the left ventricular outflow tract and aortic root. Homograft aortic roots are the conduits of choice, but because they are not available in all cases, alternative conduits are needed.
Owing to its features, which are comparable to those of homografts, the Freestyle aortic root xenograft was used in 10 consecutive patients aged between 32 and 77 years. All patients had extensive abscess formation, 5 presented with prosthetic valve endocarditis, 2 had additional mitral valve endocarditis requiring partial leaflet resection and reconstruction, 1 patient had an additional fistula into the right atrium, and 1 required coronary bypass. One patient developed a septic ventricular septal defect and fistula into the right atrium with tricuspid valve endocarditis.
None of the patients required reoperation for bleeding. Two (20%) patients died in the postoperative period, 1 due to multiorgan failure, and 1 due to preexisting invasive pulmonary aspergillosis. At autopsy, neither had evidence of intrapericardial hematoma or suture dehiscence. One patient died 13 months postoperatively without clinical signs of valve dysfunction or recurrent endocarditis. All other patients are well at 12 to 42 months after surgery. Clinical examination and echocardiography at the most recent follow-up showed no signs of valve dysfunction, recurrent fistulation, or endocarditis.
The Freestyle aortic root appears to be an acceptable alternative to homografts in the treatment of severe endocarditis. Long-term valve durability in younger patients, however, remains to be determined.
成功治疗伴有瓣环脓肿形成的破坏性主动脉瓣心内膜炎需要广泛的手术清创以及左心室流出道和主动脉根部的重建。同种异体主动脉根部是首选的管道，但由于并非所有病例都能获得，因此需要替代管道。
由于其特性与同种异体移植物相似，连续10例年龄在32至77岁之间的患者使用了Freestyle主动脉根部异种移植物。所有患者均有广泛的脓肿形成，5例表现为人工瓣膜心内膜炎，2例合并二尖瓣心内膜炎，需要部分瓣叶切除和重建，1例患者合并右心房瘘，1例需要冠状动脉搭桥。1例患者发生感染性室间隔缺损并合并右心房瘘及三尖瓣心内膜炎。
所有患者均未因出血需要再次手术。2例（20%）患者在术后死亡，1例死于多器官功能衰竭，1例死于既往存在的侵袭性肺曲霉病。尸检时，两者均无心包内血肿或缝线裂开的证据。1例患者术后13个月死亡，无瓣膜功能障碍或复发性心内膜炎的临床体征。所有其他患者在术后12至42个月情况良好。最近一次随访时的临床检查和超声心动图显示无瓣膜功能障碍、复发性瘘管形成或心内膜炎的迹象。
在治疗严重心内膜炎方面，Freestyle主动脉根部似乎是同种异体移植物的可接受替代物。然而，年轻患者的瓣膜长期耐久性仍有待确定。
