Department of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria.
Department of Heart Surgery, Medical University Innsbruck, Innsbruck, Austria.
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1265-70. doi: 10.1016/j.jtcvs.2013.05.014. Epub 2013 Jul 11.
In destructive aortic valve endocarditis with abscess formation in the root, homografts are used more often than xenografts. Because we had reliable perioperative results with Freestyle (Medtronic Inc, Minneapolis, Minn) xenograft root replacement in these complex patients, we analyzed the long-term outcome in this high-risk indication.
Of 126 consecutive patients with aortic valve endocarditis treated by surgery from 1997 to 2012, 32 (25.4%) received a Freestyle aortic root replacement for severe, destructive valve endocarditis and were studied retrospectively with approval of the local ethical committee. Perioperative complications, recurrence of endocarditis, and long-term morbidity and mortality were analyzed. The follow-up period was 3 months to 11.5 years.
Indication for surgery was native (n = 9) and prosthetic valve endocarditis (n = 23). In 18 patients, concomitant procedures were performed: coronary bypass (n = 9), additional valve surgery (n = 6), and ascending aortic surgery (n = 7). Thirty-day mortality was 19.4% (n = 6). There were no instances of technical failure requiring modification of the surgical strategy or reoperation for anastomotic bleeding. Actuarial survival at 5 and 10 years was 61.9% and 54.2%, respectively. Freedom from death, reoperation for prostheses dysfunction, and recurrence of endocarditis as the composite end point at 5 and 10 years was 56.3% and 53.1%, respectively.
The Freestyle root was used successfully with no technical complications in all patients with most severe destructive aortic root endocarditis. In view of this complex patient population, short- and long-term results make this conduit a reliable choice for treatment of this condition.
在伴有脓肿形成的破坏性主动脉瓣心内膜炎的根部，同种移植物的使用比异种移植物更为常见。由于我们在这些复杂患者中使用 Freestyle（美敦力公司，明尼苏达州明尼阿波利斯）异种移植物根部置换术获得了可靠的围手术期结果，因此我们分析了这种高危适应证的长期结果。
在 1997 年至 2012 年期间接受手术治疗的 126 例连续主动脉瓣心内膜炎患者中，有 32 例（25.4%）因严重破坏性瓣膜炎接受 Freestyle 主动脉根部置换术，并经当地伦理委员会批准进行回顾性研究。分析了围手术期并发症、心内膜炎复发以及长期发病率和死亡率。随访时间为 3 个月至 11.5 年。
手术指征为原发性（n=9）和人工瓣膜心内膜炎（n=23）。在 18 例患者中，同时进行了其他手术：冠状动脉旁路移植术（n=9）、附加瓣膜手术（n=6）和升主动脉手术（n=7）。30 天死亡率为 19.4%（n=6）。没有因技术失败需要修改手术策略或因吻合口出血需要再次手术的情况。5 年和 10 年的生存率分别为 61.9%和 54.2%。5 年和 10 年时，无死亡、因假体功能障碍而再次手术以及心内膜炎复发的复合终点发生率分别为 56.3%和 53.1%。
在所有患有最严重破坏性主动脉根部心内膜炎的患者中，Freestyle 根部均成功使用，没有出现技术并发症。鉴于这些复杂的患者人群，短期和长期结果使这种移植物成为治疗这种疾病的可靠选择。
