Sponga Sandro, Daffarra Cristian, Pavoni Daisy, Vendramin Igor, Mazzaro Enzo, Piani Daniela, Nalli Chiara, Nucifora Gaetano, Livi Ugolino
Cardiothoracic Department, University Hospital of Udine, Udine, Italy
Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Eur J Cardiothorac Surg. 2016 Jan;49(1):242-8. doi: 10.1093/ejcts/ezv068. Epub 2015 Mar 1.
The treatment of complicated aortic endocarditis with periannular abscesses and root disarrangement is a surgical challenge, and includes left ventricular outflow tract (LVOT) reconstruction with the patch technique or homograft implantation. The results of a simplified technique to reconstruct the LVOT in destructive endocarditis of either the aortic native valve or valve prosthesis with the Sorin Pericarbon Freedom stentless valve are reported.
Since August 2007, 40 patients with destructive endocarditis (mean age: 69 ± 12, 75% males, European System for Cardiac Operative Risk Evaluation II (EuroSCORE II): 19 ± 13, New York Heart Association (NYHA) class: ≥3 in all cases) have undergone LVOT reconstruction with a Sorin Pericarbon Freedom stentless bioprosthesis. Seven patients (17.5%) were in septic or cardiogenic shock preoperatively, and 18 patients (45%) suffered from moderate or severe aortic regurgitation. Eleven patients (27.5%) experienced preoperative systemic embolizations. Thirty-six cases (90%) were valve redos and 9 patients (22.5%) had concomitant procedures. The mean follow-up was 26 ± 25 months.
One patient (2.5%) died early (<30 days) and another 3 patients never discharged died due to multiorgan failure and septic shock. Actuarial survival rate was 85 ± 6% at 1 year, and 76 ± 8% at 3 and 5 years, respectively. Twelve patients (30%) required pacemaker implantation because of atrioventricular block and 20 patients (50%) developed or showed a progression of renal failure. One patient (2.5%) had an endocarditis relapse, and 1 (2.5%) showed a mild paraprosthetic aortic leak. No patient needed reoperation. At the last echocardiographic evaluation, mean gradient, peak gradient and left ventricular ejection fraction were 7.9 ± 5.0 mmHg, 15.1 ± 7.2 mmHg and 63.3 ± 9.3%, respectively.
The Sorin Pericarbon Freedom stentless prosthesis, with the modified technique herein described, seems to be a good option in most of cases of destructive aortic valve endocarditis. It is promptly available in different sizes, easy to implant and, due to its pericardial inflow skirt, ideal for extensive reconstruction of the LVOT with good haemodynamic performance and low risk of relapse.
治疗合并瓣周脓肿和根部紊乱的复杂性主动脉心内膜炎是一项外科挑战，包括采用补片技术或同种异体移植物植入进行左心室流出道（LVOT）重建。本文报道了一种使用索林Pericarbon Freedom无支架瓣膜重建主动脉自身瓣膜或人工瓣膜破坏性心内膜炎中LVOT的简化技术的结果。
自2007年8月以来，40例破坏性心内膜炎患者（平均年龄：69±12岁，75%为男性，欧洲心脏手术风险评估系统II（EuroSCORE II）：19±13，纽约心脏协会（NYHA）分级：所有病例均≥3级）接受了索林Pericarbon Freedom无支架生物假体LVOT重建。7例患者（17.5%）术前处于感染性或心源性休克，18例患者（45%）患有中度或重度主动脉瓣反流。11例患者（27.5%）术前发生全身性栓塞。36例（90%）为再次瓣膜手术，9例患者（22.5%）进行了同期手术。平均随访时间为26±25个月。
1例患者（2.5%）早期（<30天）死亡，另外3例未出院患者因多器官功能衰竭和感染性休克死亡。1年时的精算生存率为85±6%，3年和5年时分别为76±8%。12例患者（30%）因房室传导阻滞需要植入起搏器，20例患者（50%）出现或显示肾衰竭进展。1例患者（2.5%）心内膜炎复发，1例（2.5%）出现轻度人工瓣膜主动脉瓣周漏。无患者需要再次手术。在最后一次超声心动图评估时，平均压差、峰值压差和左心室射血分数分别为7.9±5.0 mmHg、15.1±7.2 mmHg和63.3±9.3%。
采用本文所述改良技术的索林Pericarbon Freedom无支架假体，在大多数主动脉瓣破坏性心内膜炎病例中似乎是一个不错的选择。它有不同尺寸可供快速使用，易于植入，并且由于其心包流入裙边，对于LVOT的广泛重建非常理想，具有良好的血流动力学性能和低复发风险。
