Saha Shekhar, Ali Ahmad, Schnackenburg Philipp, Horke Konstanze Maria, Oberbach Andreas, Schlichting Nadine, Sadoni Sebastian, Rizas Konstantinos, Braun Daniel, Luehr Maximilian, Bagaev Erik, Hagl Christian, Joskowiak Dominik
Department of Cardiac Surgery, Ludwig Maximillian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, 80802 Munich, Germany.
J Clin Med. 2022 Jun 14;11(12):3418. doi: 10.3390/jcm11123418.
: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. : Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. : The median EuroSCORE II (52.1 (40.6-62.0) v/s 45.4 (32.6-58.1), = 0.207) and STS-PROM (1.8 (1.6-2.1) v/s 1.9 (1.4-2.2), = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020.Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group ( = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement ( = 0.081). : Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.
由于经导管主动脉瓣置换术后感染性心内膜炎的手术经验较少,本研究比较了外科主动脉瓣置换术和经导管主动脉瓣置换术后感染性心内膜炎患者的围手术期和短期结局。2013年1月至2020年12月期间,468例连续患者因感染性心内膜炎入住我们中心接受手术。其中,98例接受了外科主动脉瓣置换术后感染性心内膜炎手术,22例接受了经导管主动脉瓣置换术后感染性心内膜炎手术。欧洲心脏手术风险评估系统II中位数(52.1(40.6 - 62.0)对45.4(32.6 - 58.1),P = 0.207)和胸外科医师协会预计风险(1.8(1.6 - 2.1)对1.9(1.4 - 2.2),P = 0.622)具有可比性。经导管主动脉瓣置换术后感染性心内膜炎在2013年至2015年期间占人工主动脉瓣心内膜炎的13.7%;在2019年和2020年这一比例增至26.9%。35例患者(29.2%)进行了同期手术。外科主动脉瓣置换术后感染性心内膜炎组的手术死亡率为26.5%,经导管主动脉瓣置换术后感染性心内膜炎组为9.1%(P = 0.098)。随访时发现,外科主动脉瓣置换术后感染性心内膜炎组6个月生存率为98%,经导管主动脉瓣置换术后感染性心内膜炎组为89%(P = 0.081)。外科主动脉瓣置换术和经导管主动脉瓣置换术后感染性心内膜炎患者的风险特征具有可比性,手术治疗效果也相当。即使在这一中度风险队列中,作为治愈选择的手术也不应被拒绝。