Pollari Francesco, Ziegler Renate, Nappi Francesco, Großmann Irena, Steinmann Jörg, Fischlein Theodor
Department of Cardiac Surgery, Medical Microbiology and Infectiology, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany.
Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany.
Ann Transl Med. 2020 Dec;8(23):1629. doi: 10.21037/atm-20-4630.
Transcatheter aortic valve implantation (TAVI) and sutureless aortic valve replacement (Su-AVR) enabled in the last years many patients at high or prohibitive risk to be treated for their severe symptomatic aortic valve stenosis. As often happens in medicine, new techniques bring not only new hopes, but also new problems. In recent years, alongside the lengthening of the life of these patients treated with TAVI or Su-AVR, cardiologists and cardiac surgeons have had to face the long-term complications associated with the implantation of these devices, such as the prosthetic infective endocarditis. The correct management of prosthesis valve endocarditis after TAVI or Su-AVR in high risk patients, and the possible role of surgery are a matter of debate because pushing the limits of the modern medicine and becoming a new challenge for cardiac surgeons of 21 century. In this review, we summarized the incidence, characteristics and evidences for this new and controversial problem of the cardiovascular community. Moreover, we investigated the outcomes reported in literature of the conservative and the surgical strategy. Although the reported mortality rate of surgical treatment is high, seems not prohibitive, mostly if compared to conservative medical therapy. The collaborative exchange between cardiologist, cardiac surgeons, clinical microbiologists and expert of imaging is mandatory to face this challenge.
近年来，经导管主动脉瓣植入术（TAVI）和无缝合主动脉瓣置换术（Su-AVR）使许多高危或手术禁忌的患者能够接受严重症状性主动脉瓣狭窄的治疗。医学领域经常出现这种情况，新技术不仅带来了新希望，也带来了新问题。近年来，随着接受TAVI或Su-AVR治疗的患者寿命延长，心脏病专家和心脏外科医生不得不面对与这些装置植入相关的长期并发症，如人工瓣膜感染性心内膜炎。对于高危患者TAVI或Su-AVR术后人工瓣膜心内膜炎的正确管理以及手术的可能作用存在争议，因为这突破了现代医学的极限，成为21世纪心脏外科医生面临的新挑战。在本综述中，我们总结了心血管领域这一全新且有争议问题的发病率、特征和证据。此外，我们研究了文献中报道的保守治疗和手术策略的结果。尽管报道的手术治疗死亡率很高，但似乎并非不可接受，尤其是与保守药物治疗相比。心脏病专家、心脏外科医生、临床微生物学家和影像学专家之间的协作交流对于应对这一挑战至关重要。
