Foghsgaard Signe, Bruun Niels, Kjaergard Henrik
Department of Cardiothoracic Surgery, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Scand J Infect Dis. 2008;40(3):216-20. doi: 10.1080/00365540701632980. Epub 2007 Sep 6.
The objective of the study was to evaluate the results of treatment of severe aortic endocarditis with an aortic homograft (an aortic valve and root from a donor) in combination with antibiotic therapy. 24 patients with either aortic prosthetic valve endocarditis (n=16) or severe aortic native valve endocarditis (n=8) with destruction of 1 or more cusps, paravalvular abscess formation and/or cardiac fistulas caused by aggressive bacteria, underwent surgery in 1997-2006. Staphylococcal species were the most common pathogens followed by streptococci. Intravenous antibiotic therapy was started before surgery and continued for at least 4-6 weeks. Three patients with prosthetic valve endocarditis died within the first 24 h after surgery from heart failure. Two of these patients required an additional implantation of a mitral valve prosthesis. Five patients died from non-cardiac causes within 1-7 y of surgery. Within the follow-up period no patients had relapse of endocarditis, and only 1 episode of recurrent endocarditis in an intravenous drug abuser was registered. In conclusion, an aortic homograft in combination with intravenous antibiotics is an excellent option for treatment of severe aortic endocarditis.
本研究的目的是评估使用主动脉同种异体移植物（来自供体的主动脉瓣和主动脉根部）联合抗生素治疗严重主动脉心内膜炎的效果。1997年至2006年期间，24例患有主动脉人工瓣膜心内膜炎（n = 16）或严重主动脉天然瓣膜心内膜炎（n = 8）且伴有1个或更多瓣叶破坏、瓣周脓肿形成和/或由侵袭性细菌引起的心内瘘的患者接受了手术。葡萄球菌是最常见的病原体，其次是链球菌。术前开始静脉抗生素治疗，并持续至少4 - 6周。3例人工瓣膜心内膜炎患者术后24小时内死于心力衰竭。其中2例患者需要额外植入二尖瓣人工瓣膜。5例患者在术后1 - 7年内死于非心脏原因。在随访期间，没有患者发生心内膜炎复发，仅记录到1例静脉药物滥用者发生复发性心内膜炎。总之，主动脉同种异体移植物联合静脉抗生素是治疗严重主动脉心内膜炎的极佳选择。
