Nappi Francesco, Singh Sanjeet Singh Avtaar, Lusini Mario, Nenna Antonio, Gambardella Ivancarmine, Chello Massimo
Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, Paris, France.
Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.
Ann Transl Med. 2019 Sep;7(18):491. doi: 10.21037/atm.2019.08.76.
The surgical treatment of aortic valve endocarditis (AVE) is generally performed using conventional mechanical or biological xenograft prosthesis, with limited use of aortic homograft (Ao-Homo) or pulmonary autograft (PA). Clinical evidence has demonstrated a clear contradiction between the proven benefits of Ao-Homo and PA in the context of infection and the very limited use of allogenic or autologous tissue in everyday clinical practice. This review aims to summarize the most recent and relevant literature in order to foster the scientific debate on the use of the use of allogenic and autologous tissue to treat AVE. The decisional process of the Heart Team should also include the preferences of the patient, his/her family, the general cardiologist or primary care physician. The use of allogenic or autologous valve substitute is beneficial if there is a high risk of recurrence of infection, avoiding extensive adhesiolysis and debridement of synthetic material. In any case, those procedures should be performed by highly trained centers to optimize outcomes.
主动脉瓣心内膜炎(AVE)的外科治疗通常采用传统的机械或生物异种移植人工瓣膜,主动脉同种异体移植物(Ao-Homo)或肺动脉自体移植物(PA)的使用有限。临床证据表明,在感染情况下,Ao-Homo和PA已证实的益处与日常临床实践中同种异体或自体组织的使用非常有限之间存在明显矛盾。本综述旨在总结最新的相关文献,以促进关于使用同种异体和自体组织治疗AVE的科学辩论。心脏团队的决策过程还应包括患者、其家属、普通心脏病专家或初级保健医生的偏好。如果存在感染复发的高风险,使用同种异体或自体瓣膜替代物是有益的,可避免广泛的粘连松解和合成材料清创。无论如何,这些手术应由训练有素的中心进行,以优化治疗效果。