Elderia Ahmed, Wallau Anna-Maria, Bennour Walid, Gerfer Stephen, Gaisendrees Christopher, Krasivskyi Ihor, Djordjevic Ilija, Wahlers Thorsten, Weber Carolyn
Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Köln, Germany.
Life (Basel). 2024 Jan 7;14(1):92. doi: 10.3390/life14010092.
Locally destructive infective endocarditis (IE) of the aortic valve complicated by abscess formation in the aortic root may seriously affect patients' outcomes. Surgical repair of such conditions is often challenging. This is a single-center observational analysis of consecutive patients treated surgically for IE between 2009 and 2019. We divided the cohort into two groups considering the presence of an aortic root abscess and compared the characteristics and postoperative outcomes of patients accordingly. Moreover, we examined three different procedures performed in abscess patients regarding operative data and postoperative results: an isolated surgical aortic valve replacement (AVR), AVR with patch reconstruction of the aortic root (AVR + RR) or the Bentall procedure. The whole cohort comprised 665 patients, including 140 (21.0%) patients with an aortic root abscess and 525 (78.9%) as the control group. The abscess group of patients received either AVR (66.4%), AVR + RR (17.8%), or the Bentall procedure (15.7%). The mean age in the whole cohort was 62.1 ± 14.8. The mean EuroSCORE II was 8.0 ± 3.5 in the abscess group and 8.4 ± 3.7 in the control group ( = 0.259). The 30-day and 1-year mortality rates were 19.6% vs. 11.3% ( = 0.009) and 40.1% vs. 29.6% ( = 0.016) in the abscess compared to the control group. The multivariable regression analysis did not reveal aortic root abscess as an independent predictor of mortality. Rather, age > 60 correlated with 30-day mortality and infection with spp. correlated with 1-year mortality. In the analysis according to the performed procedures, KM estimates exhibited comparable long-term survival (log-rank = 0.325). IE recurrence was noticed in 12.3% of patients after AVR, 26.7% after AVR + RR and none after Bentall ( = 0.069). We concluded that patients with an aortic root abscess suffer worse short and long-term outcomes compared to other IE patients. The post-procedural survival among ARA patients did not significantly vary based on the procedures performed.
主动脉瓣局部破坏性感染性心内膜炎（IE）合并主动脉根部脓肿形成可能会严重影响患者的预后。对此类病症进行手术修复往往具有挑战性。这是一项对2009年至2019年间接受IE手术治疗的连续患者进行的单中心观察性分析。我们根据是否存在主动脉根部脓肿将队列分为两组，并相应比较了患者的特征和术后结果。此外，我们研究了脓肿患者所进行的三种不同手术的手术数据和术后结果：单纯外科主动脉瓣置换术（AVR）、主动脉根部补片重建的AVR（AVR + RR）或Bentall手术。整个队列包括665例患者，其中140例（21.0%）有主动脉根部脓肿，525例（78.9%）作为对照组。脓肿组患者接受AVR的占66.4%，接受AVR + RR的占17.8%，接受Bentall手术的占15.7%。整个队列的平均年龄为62.1±14.8岁。脓肿组的平均欧洲心脏手术风险评估系统（EuroSCORE）II评分为8.0±3.5，对照组为8.4±3.7（P = 0.259）。与对照组相比，脓肿组的30天和1年死亡率分别为19.6%对11.3%（P = 0.009）和40.1%对29.6%（P = 0.016）。多变量回归分析未显示主动脉根部脓肿是死亡率的独立预测因素。相反，年龄>60岁与30天死亡率相关，感染[具体菌种]与1年死亡率相关。在根据所实施手术进行的分析中，Kaplan-Meier估计显示长期生存率相当（对数秩检验P = 0.325）。AVR术后12.3%的患者出现IE复发，AVR + RR术后为26.7%，Bentall手术后无复发（P = 0.069）。我们得出结论，与其他IE患者相比，有主动脉根部脓肿的患者短期和长期预后更差。基于所实施的手术，主动脉根部脓肿患者术后生存率无显著差异。
