Division of Pediatric and Congenital Heart Surgery, Kepler University Hospital, JKU, Linz, Austria.
Department for Thoracic and Cardiovascular Surgery, Kepler University Hospital, JKU, Linz, Austria.
Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1322-1328. doi: 10.1093/ejcts/ezab086.
Percutaneous pulmonary valve prostheses and right ventricle-to-pulmonary artery conduits are at risk for infective endocarditis (IE). In children and adults with a congenital heart disease, a pulmonary valve implant is frequently necessary. Prosthetic valve endocarditis is a conservatively barely manageable, serious life-threatening condition. We investigated the results of surgical pulmonary valve replacements in patients with IE.
A total of 20 patients with congenital heart disease with the definite diagnosis of IE between March 2013 and July 2020 were included in this single institutional, retrospective review. Infected conduits were 11 Melody, 5 Contegra, 3 homografts and 1 Matrix P Plus. All of the infected prosthetic material was removed from the right ventricular outflow tract up to the pulmonary bifurcation. Pulmonary homografts were implanted after pulmonary root resection as right ventricle-to-pulmonary artery conduits.
All patients survived and were discharged infection-free. The mean time from the conduit implant to the operation for IE was 4.9 years [95% confidence interval (CI), 3.0-6.9]. The median intensive care unit stay was 3.0 days (95% CI, 2.0-4.7), and the median hospital time was 25.0 days (95% CI, 19.2-42.0). Median follow-up time was 204.5 days (range 30 days to 5 years) without death or recurrent endocarditis.
The surgical treatment of IE of percutaneous pulmonary valve prostheses and right ventricle-to-pulmonary artery conduits is a safe and effective therapeutic concept. Early surgical referral of patients with suspicion of IE should be pursued to avoid sequelae such as right ventricular failure, septic emboli, intracardiac expansion and antibiotic resistance.
经皮肺动脉瓣假体和右心室至肺动脉导管有发生感染性心内膜炎（IE）的风险。在患有先天性心脏病的儿童和成人中，经常需要植入肺动脉瓣。人工瓣膜心内膜炎是一种保守治疗效果差、严重危及生命的疾病。我们研究了 IE 患者行外科肺动脉瓣置换术的结果。
本单中心回顾性研究共纳入 2013 年 3 月至 2020 年 7 月期间明确诊断为 IE 的 20 例先天性心脏病患者。感染的导管为 11 个 Melody、5 个 Contegra、3 个同种移植物和 1 个 Matrix P Plus。所有感染的人工瓣膜材料均从右心室流出道至肺动脉分叉处取出。同种异体肺动脉根切除后作为右心室至肺动脉导管植入肺动脉同种移植物。
所有患者均存活且无感染性并发症出院。从导管植入到 IE 手术的平均时间为 4.9 年[95%置信区间（CI）：3.0-6.9]。中位重症监护病房住院时间为 3.0 天（95%CI：2.0-4.7），中位住院时间为 25.0 天（95%CI：19.2-42.0）。中位随访时间为 204.5 天（范围 30 天至 5 年），无死亡或复发性心内膜炎。
经皮肺动脉瓣假体和右心室至肺动脉导管 IE 的外科治疗是一种安全有效的治疗方案。对于怀疑 IE 的患者，应尽早进行外科转诊，以避免发生右心衰竭、脓毒性栓子、心内扩张和抗生素耐药等并发症。
