Bearpark Lisa O F, Sartipy Ulrik, Franco-Cereceda Anders, Glaser Natalie
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden.
Ann Cardiothorac Surg. 2022 Jul;11(4):448-458. doi: 10.21037/acs-2022-bav-fs-0062.
The objective of this study is to investigate clinical outcomes in patients with bicuspid aortic valves (BAV) after surgical treatment for endocarditis.
This was a population-based, observational cohort study, conducted on all patients who received aortic valve surgery for native or prosthetic valve endocarditis at Karolinska University Hospital between 2002-2020. Baseline characteristics and postoperative complications were collected from the institutional surgical database and patient medical charts. The primary endpoint was all-cause mortality. We used unadjusted and adjusted Cox regression to determine the association between valve morphology and long-term mortality.
Of the 338 patients, 122 (36%) had a BAV and 216 (64%) had a tricuspid aortic valve (TAV). The mean follow-up was 5.8 years (maximum 18.4 years). Survival rates at one, five, ten and 14 years were 88%, 81%, 78% and 76% versus 85%, 69%, 58% and 43%, in BAV and TAV patients, respectively [adjusted hazard ratio (HR) 0.64; 95% confidence interval (CI): 0.39-1.05]. In patients with native valve endocarditis, those with BAV had lower all-cause mortality compared to those with TAV (adjusted HR 0.44; 95% CI: 0.22-0.89), despite having a higher prevalence of perivalvular abscess (40% versus 22%, respectively, in BAV and TAV patients). In patients with prosthetic valve endocarditis, original valve morphology did not affect all-cause mortality (adjusted HR 1.94; 95% CI: 0.64-5.87).
In patients with native valve endocarditis, a BAV was associated with improved survival after surgical treatment. In patients with prosthetic valve endocarditis, survival was not affected by the original valve morphology of the patient.
本研究的目的是调查二叶式主动脉瓣（BAV）患者在接受心内膜炎手术治疗后的临床结局。
这是一项基于人群的观察性队列研究，研究对象为2002年至2020年期间在卡罗林斯卡大学医院接受主动脉瓣手术治疗原发性或人工瓣膜心内膜炎的所有患者。从机构手术数据库和患者病历中收集基线特征和术后并发症。主要终点是全因死亡率。我们使用未调整和调整后的Cox回归来确定瓣膜形态与长期死亡率之间的关联。
338例患者中，122例（36%）为BAV，216例（64%）为三叶式主动脉瓣（TAV）。平均随访时间为5.8年（最长18.4年）。BAV和TAV患者1年、5年、10年和14年的生存率分别为88%、81%、78%和76%，而TAV患者分别为85%、69%、58%和43%[调整后风险比（HR）0.64；95%置信区间（CI）：0.39-1.05]。在原发性瓣膜心内膜炎患者中，BAV患者的全因死亡率低于TAV患者（调整后HR 0.44；95%CI：0.22-0.89），尽管瓣周脓肿的患病率较高（BAV和TAV患者分别为40%和22%）。在人工瓣膜心内膜炎患者中，原始瓣膜形态不影响全因死亡率（调整后HR 1.94；95%CI：0.64-5.87）。
在原发性瓣膜心内膜炎患者中，BAV与手术治疗后的生存率提高相关。在人工瓣膜心内膜炎患者中，患者的原始瓣膜形态不影响生存率。
