Kim Kyung-Hwan, Kim Hong Kwan, Kim Ki-Bong, Ahn Hyuk
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Heart Surg Forum. 2006;9(1):E506-10. doi: 10.1532/HSF98.20051160.
Aortic valve endocarditis with paraannular abscess remains a challenging problem in the surgical treatment of native and prosthetic valve endocarditis. The purpose of this study is to evaluate the long-term outcome of surgical intervention for aortic paraannular abscess.
From January 1989 to November 2004, 32 consecutive patients (24 men, 8 women) were studied. Mean age was 50.6 +/- 16.2 (range, 17-80) years. Twenty-four had native valve endocarditis and 8 had prosthetic valve endocarditis. Eight of 24 patients who suffered from native valve endocarditis had bicuspid valve endocarditis. The predominant microorganism was Streptococcus viridans. No microorganisms were identified in 11 patients. Most patients were desperately ill at the time of surgery. Repair was performed by aggressive eradication of infected tissue and reconstruction of the defect with autologous pericardium (n = 24), bovine pericardium (n = 3), Dacron patch (n = 4), and primary closure (n = 1).
Although postoperative complications were common, early mortality occurred in only 4 patients (12.5%). Operative survivors have been followed for 5 months to 16 years (mean, 92.7 months). There were 2 late deaths but all were noncardiac deaths. Five patients (15.6%) underwent reoperation at a mean of 55.4 months after the initial surgery. The actuarial survival at 1, 5, and 10 years was 87.4% +/- 5.9%, 83.2% +/- 6.9%, and 79.1% +/- 7.7%, respectively. The freedom from reoperation at 1, 5, and 10 years was 88.7% +/- 6.2%, 79.8% +/- 8.1% and 75.4% +/- 8.8%, respectively.
These data suggest that aggressive surgical intervention and meticulous antibiotic therapy for aortic valve endocarditis with paraannular abscess yields a high success rate with relatively low mortality and good long-term results.
主动脉瓣心内膜炎合并瓣周脓肿仍是自体瓣膜和人工瓣膜心内膜炎外科治疗中的一个难题。本研究的目的是评估主动脉瓣周脓肿手术干预的长期疗效。
对1989年1月至2004年11月期间连续收治的32例患者（24例男性，8例女性）进行研究。平均年龄为50.6±16.2（范围17 - 80）岁。24例为自体瓣膜心内膜炎，8例为人工瓣膜心内膜炎。24例自体瓣膜心内膜炎患者中有8例为二叶式瓣膜心内膜炎。主要微生物为草绿色链球菌。11例患者未鉴定出微生物。大多数患者在手术时病情危急。通过积极清除感染组织并用自体心包（n = 24）、牛心包（n = 3）、涤纶补片（n = 4）修复缺损以及一期缝合（n = 1）进行修复。
尽管术后并发症常见，但仅4例患者（12.5%）发生早期死亡。手术存活者随访时间为5个月至16年（平均92.7个月）。有2例晚期死亡，但均为非心脏性死亡。5例患者（15.6%）在初次手术后平均55.4个月接受了再次手术。1年、5年和10年的精算生存率分别为87.4%±5.9%、83.2%±6.9%和79.1%±7.7%。1年、5年和10年免于再次手术的比例分别为88.7%±6.2%、79.8%±8.1%和75.4%±8.8%。
这些数据表明，对主动脉瓣心内膜炎合并瓣周脓肿进行积极的手术干预和细致的抗生素治疗可获得较高的成功率，死亡率相对较低，且长期效果良好。
