Haidari Zaki, Ahmad Shehla Ufaq, Knipp Stephan, Turaev Iskandar, El Gabry Mohamed
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, 45147 Essen, Germany.
J Cardiovasc Dev Dis. 2024 Jun 24;11(7):189. doi: 10.3390/jcdd11070189.
Infective endocarditis of the aortic valve complicated by annular abscess is a challenging problem and often requires patch reconstruction after surgical debridement of the abscess cavity. Filling the remaining cavity with antibiotics is advocated to prevent recurrent endocarditis. This study aimed at evaluating the role of local antibiotics in patients with aortic valve infective endocarditis complicated by annular abscess.
Between January 2012 and December 2021, all consecutive patients with aortic valve infective endocarditis complicated by annular abscess undergoing cardiac surgery and annular patch reconstruction were included. Patients receiving local antibiotics were compared with patients without local antibiotics. The primary endpoints were the incidence of recurrent endocarditis, re-operation, and mortality during two-year follow-up.
A total of 41 patients with aortic valve infective endocarditis complicated by annular abscess underwent surgical patch reconstruction after radical debridement. In total, 20 patients received local antibiotics in the abscess cavity and 21 patients were treated without local antibiotics. The most common causative microorganisms were the staphylococci species and the most common location of the abscess was the non-coronary annulus. During two-year follow-up, one patient in each group developed recurrent endocarditis ( > 0.99) and both patients were reoperated ( > 0.99). Two-year mortality was 30% in the local antibiotic group and 24% in the control group ( = 0.65).
Radical debridement and patch reconstruction of the aortic annulus in patients with aortic valve infective endocarditis complicated by annular abscess is an effective surgical strategy. Filling of the remaining abscess cavity with antibiotic seems not to affect the rate of recurrent endocarditis, reoperation, and mortality during two-year follow-up.
主动脉瓣感染性心内膜炎合并瓣环脓肿是一个具有挑战性的问题，通常需要在脓肿腔手术清创后进行补片重建。提倡用抗生素填充剩余腔隙以预防感染性心内膜炎复发。本研究旨在评估局部应用抗生素在主动脉瓣感染性心内膜炎合并瓣环脓肿患者中的作用。
纳入2012年1月至2021年12月期间所有连续接受心脏手术及瓣环补片重建的主动脉瓣感染性心内膜炎合并瓣环脓肿患者。将接受局部抗生素治疗的患者与未接受局部抗生素治疗的患者进行比较。主要终点是两年随访期间感染性心内膜炎复发、再次手术和死亡率。
共有41例主动脉瓣感染性心内膜炎合并瓣环脓肿患者在彻底清创后接受了手术补片重建。总共有20例患者在脓肿腔内接受了局部抗生素治疗，21例患者未接受局部抗生素治疗。最常见的致病微生物是葡萄球菌属，脓肿最常见的部位是非冠状动脉瓣环。在两年随访期间，每组各有1例患者发生感染性心内膜炎复发（P>0.99），两名患者均接受了再次手术（P>0.99）。局部抗生素组两年死亡率为30%，对照组为24%（P=0.65）。
对于主动脉瓣感染性心内膜炎合并瓣环脓肿患者，对主动脉瓣环进行彻底清创和补片重建是一种有效的手术策略。用抗生素填充剩余脓肿腔似乎不影响两年随访期间感染性心内膜炎复发率、再次手术率和死亡率。
