Department of Cardiovascular Surgery and Anesthesia, Sahlgrenska University Hospital, Gothenburg, Sweden.
Ann Thorac Surg. 2010 Dec;90(6):1862-7. doi: 10.1016/j.athoracsur.2010.06.100.
Treatment of prosthetic aortic valve endocarditis and native aortic valve endocarditis with abscess formation is associated with high mortality and morbidity. Aortic root replacement with a freestanding aortic homograft is an attractive alternative. We report outcome and quality of life after homograft replacement for infective endocarditis.
Sixty-two patients with infective prosthetic valve endocarditis (n = 31) or native valve endocarditis with abscess (n = 31), operated with homograft replacement were included. Thirty-day mortality, severe operative complications (dialysis, stroke, pacemaker implantation, myocardial infarction, and prolonged mechanical ventilation), midterm survival, reoperations, and quality of life were assessed after a mean follow-up of 37 ± 11 months.
Nine patients (15%) died within 30 days and 22 patients (35%) had severe perioperative complications. Preoperative and perioperative variables univariately associated with early mortality were higher (Cleveland Clinic risk score [p = 0.014], extracorporeal circulation time [p = 0.003], prolonged inotropic support [p = 0.03], reoperation for bleeding [p = 0.01], and perioperative myocardial infarction [p < 0.001].) Cumulative survival was 82%, 78%, 75%, and 67% at one, three, five, and ten years, respectively. One patient was reoperated due to recurrence of endocarditis nine months after surgery and one after five years due to homograft failure. Quality of life, as assessed by the 36 item short-form health survey scales for physical and mental health, was not significantly different to an age-matched and gender-matched healthy control group.
Severe acute aortic endocarditis treated with homograft replacement is still associated with a substantial early complication rate and mortality. Long-term survival and quality of life are satisfactory in patients surviving the immediate postoperative period.
采用独立带瓣主动脉同种异体移植进行人工主动脉瓣心内膜炎和原生主动脉瓣心内膜炎合并脓肿的治疗，其死亡率和发病率均较高。采用独立带瓣主动脉同种异体移植进行主动脉根部置换是一种有吸引力的替代方法。我们报告了感染性心内膜炎采用同种异体移植置换后的结果和生活质量。
共有 62 例感染性人工瓣膜心内膜炎（n = 31）或合并脓肿的原生瓣膜心内膜炎（n = 31）患者接受同种异体移植置换术。在平均随访 37 ± 11 个月后，评估 30 天死亡率、严重手术并发症（透析、中风、起搏器植入、心肌梗死和长时间机械通气）、中期生存率、再次手术和生活质量。
9 例（15%）患者在 30 天内死亡，22 例（35%）患者发生严重围手术期并发症。术前和围手术期变量中，与早期死亡相关的变量为较高的（克利夫兰诊所风险评分 [p = 0.014]、体外循环时间 [p = 0.003]、长时间正性肌力支持 [p = 0.03]、因出血而再次手术 [p = 0.01]和围手术期心肌梗死 [p < 0.001]。）1 年、3 年、5 年和 10 年的累积生存率分别为 82%、78%、75%和 67%。1 例患者在手术后 9 个月因心内膜炎复发而再次手术，1 例患者在手术后 5 年因同种异体移植物失败而再次手术。采用 36 项简明健康调查问卷量表评估的生活质量，在身体和心理健康方面与年龄和性别匹配的健康对照组无显著差异。
采用独立带瓣主动脉同种异体移植治疗严重急性主动脉心内膜炎仍与较高的早期并发症发生率和死亡率相关。在度过术后早期的患者中，长期生存率和生活质量令人满意。
