Easo Jerry, Szczechowicz Marcin, Hoelzl Philipp, Horst Michael, Eichstaedt Harald, Zhigalov Konstantin, Mashhour Ahmed, Weymann Alexander, Dapunt Otto E
Department of Cardiac Surgery, European Medical School Oldenburg-Groningen, University Clinic Oldenburg, Oldenburg, Germany.
Department of Cardiac and Thoracic Surgery, HELIOS Hospital Siegburg, Siegburg, Germany.
J Card Surg. 2019 Oct;34(10):957-964. doi: 10.1111/jocs.14176. Epub 2019 Aug 2.
Aortic valve and prosthetic valve endocarditis present a challenging subgroup of patients at high risk. We analyzed our experience using the Medtronic Freestyle in full root technique for the treatment of these cases over 18-year time period.
We investigated the endocarditis subgroup from our cohort of 971 patients and compared results against other valve types with propensity score matching implementing nearest neighbor method. T-test, χ test, logistic regression, and Cox regression were performed.
Fifty-four patients from the Freestyle group (FS) were matched against 54 patients from a cohort of 376 aortic valve/root endocarditis patients treated by other valve types (non-FS). Hospital mortality was 9/54 (16.7%) in the FS vs 13/54 (24.1%) in the non-FS group (P = .33). Variables age (P = .003) and renal impairment (P = .026) had an impact on mortality according to Cox regression analysis for early results. Variables with significant risk for long-term mortality included postoperative renal impairment (P = .0001) and multiorgan failure (P = .0001). Recurrent infection was low (1.8% for FS and 3.7% for non-FS group), and freedom from reoperation was 97.2%. Use of the Medtronic Freestyle was no significant risk factor for long-term mortality.
The Freestyle stentless xenograft is a viable alternative for treatment of valve/root and prosthetic endocarditis. In our experience, it showed good postoperative performance with low rate of reinfection while having an acceptable operative risk-profile for this high-risk cohort.
主动脉瓣及人工瓣膜心内膜炎是高危患者中具有挑战性的亚组。我们分析了在18年期间使用美敦力Freestyle全根部技术治疗这些病例的经验。
我们在971例患者队列中调查了心内膜炎亚组，并通过倾向评分匹配法（采用最近邻法）将结果与其他瓣膜类型进行比较。进行了t检验、χ检验、逻辑回归和Cox回归分析。
Freestyle组（FS）的54例患者与376例接受其他瓣膜类型治疗的主动脉瓣/根部心内膜炎患者队列中的54例患者进行匹配（非FS）。FS组的医院死亡率为9/54（16.7%），非FS组为13/54（24.1%）（P = 0.33）。根据早期结果的Cox回归分析，变量年龄（P = 0.003）和肾功能损害（P = 0.026）对死亡率有影响。具有长期死亡显著风险的变量包括术后肾功能损害（P = 0.0001）和多器官功能衰竭（P = 0.0001）。再感染率较低（FS组为1.8%，非FS组为3.7%），再次手术的无事件生存率为97.2%。使用美敦力Freestyle不是长期死亡的显著危险因素。
Freestyle无支架异种移植物是治疗瓣膜/根部及人工瓣膜心内膜炎的可行替代方案。根据我们的经验，它术后表现良好，再感染率低，同时对于这个高危队列具有可接受的手术风险概况。
