Department of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland.
Ann Thorac Surg. 2010 Apr;89(4):1180-5. doi: 10.1016/j.athoracsur.2010.01.041.
Conventional annuloplasty rings consist of woven, nondegradable prosthetic material. Their use should theoretically be limited in acute infective endocarditis. Novel biodegradable annuloplasty rings, which are implanted into the annulus, carry theoretical advantages, but have never been evaluated for feasibility and mid-term outcome in such patients.
Between 2004 and 2009, 17 consecutive patients with acute infective endocarditis (age, 34.5+/-21.6 years; range, 11-82 years; 8 men) had mitral (n=13), tricuspid (n=3), and mitral and tricuspid (n=1) annuloplasty to conclude valve repair. Repair was performed by complete excision of the infected tissue, valvar reconstruction, and biodegradable ring annuloplasty. Prospectively collected clinical and echocardiographic data were analyzed retrospectively.
Indications for surgery were heart failure (n=9; 52.9%), hemodynamic instability (n=8; 47%), and persistent infection or sepsis despite antibiotics (n=6; 35.3%). Staphylococci (n=7) and Streptococci (n=4) were the most common causes. Three patients died on postoperative days 1, 2, and 34 because of massive gastrointestinal bleeding; heart failure and pneumonia; and sepsis and acute renal failure, respectively. During a median follow-up of survivors at 29.6 months (range, 2.0 to 51.0 months), no mortality, recurrence, or reoperation occurred. At follow-up, transthoracic echocardiography revealed no or trivial regurgitation in 11 and mild in 3 patients. Left ventricular dimensions regressed significantly after mitral repair.
Valve repair using a biodegradable ring showed good structural and functional properties up to 4 years after repair. Implantation of the biodegradable ring is feasible and effective in patients with acute infective endocarditis. Its intraannular implantation, hindering direct blood contact and associated risk of colonization, represents a theoretical advantage in such patients. Larger comparative studies are needed for further conclusions.
传统的瓣环成形环由编织的、不可降解的假体材料组成。理论上，它们的使用应限于急性感染性心内膜炎。新型可生物降解的瓣环成形环被植入瓣环，具有理论上的优势，但从未在这些患者中评估其可行性和中期结果。
2004 年至 2009 年，连续 17 例急性感染性心内膜炎患者（年龄 34.5+/-21.6 岁；范围 11-82 岁；男 8 例）行二尖瓣（n=13）、三尖瓣（n=3）和二尖瓣及三尖瓣（n=1）瓣环成形术以完成瓣膜修复。修复方法是完全切除感染组织、瓣膜重建和可生物降解环瓣环成形术。前瞻性收集的临床和超声心动图数据进行回顾性分析。
手术指征为心力衰竭（n=9；52.9%）、血流动力学不稳定（n=8；47%）和尽管使用抗生素仍持续感染或败血症（n=6；35.3%）。最常见的病原体是葡萄球菌（n=7）和链球菌（n=4）。3 例患者分别于术后第 1、2 和 34 天因大量胃肠道出血、心力衰竭和肺炎以及败血症和急性肾功能衰竭而死亡。在幸存者的中位随访 29.6 个月（范围 2.0 至 51.0 个月）期间，无死亡、复发或再次手术。在随访时，经胸超声心动图显示 11 例患者无或轻微反流，3 例患者轻度反流。二尖瓣修复后左心室尺寸明显回缩。
在修复后 4 年内，使用可生物降解环进行瓣膜修复显示出良好的结构和功能特性。在急性感染性心内膜炎患者中，可生物降解环的植入是可行和有效的。其在瓣环内的植入，阻碍了直接的血液接触和相关的定植风险，在这些患者中代表了一种理论优势。需要更大的比较研究来得出进一步的结论。
