Heller Anton, Zerdzitzki Matthäus, Hegner Philipp, Song Zhiyang, Schach Christian, Hitzenbichler Florian, Kozakov Kostiantyn, Thiedemann Claudius, Provaznik Zdenek, Schmid Christof, Li Jing
Department of Cardiothoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
Department of Vascular Surgery, University Medical Center Regensburg, 93053 Regensburg, Germany.
Life (Basel). 2024 Aug 19;14(8):1029. doi: 10.3390/life14081029.
Native (NVE) and prosthetic (PVE) aortic valve endocarditis (AVE) remain a surgical challenge with an ongoing trend towards more complex surgical procedures. First-time NVE was compared with PVE, focusing on pathogens, risk factors, perioperative course, postoperative follow-up, including recurrent infection, as well as health-related quality of life (HRQOL). From 2007 to 2022, surgical intervention for AVE was necessary in 231 patients with 233 episodes of infective aortic valve endocarditis, i.e., there were only two cases of reinfection (NVE group). The study group consisted of 130 cases with NVE and 103 with PVE. Overall, a median of 40.3% of survivors were in NYHA class I or II. In-hospital mortality was higher in the PVE group with 13.3%. The most common pathogen was , with 24.9% across both groups. EuroSCORE II was higher in the PVE group (19.0 ± 14.3% total, NVE 11.1 ± 8.1%, PVE 27.8 ± 14.6%; < 0.05), reflecting an older, more co-morbid patient cohort. Abscess formation was also more common in the PVE group, while vegetations were more common in the NVE group. The 5-year and 10-year survival rates did not differ significantly between NVE and PVE and were 74.4% and 52.2% for the NVE group, respectively, and 67.4% and 52.9% for the PVE group, respectively. The HRQOL as assessed by the Minnesota Living with HF Questionnaire (MLHFQ) demonstrated no significant difference between both groups. Long-term survival and QoL after surgical treatment of infective aortic valve endocarditis are excellent and do not depend on the type of replacement.
自体（NVE）和人工（PVE）主动脉瓣心内膜炎（AVE）仍然是一项外科挑战，且外科手术程序愈发复杂的趋势仍在持续。将首次发生的NVE与PVE进行比较，重点关注病原体、危险因素、围手术期过程、术后随访（包括反复感染）以及健康相关生活质量（HRQOL）。2007年至2022年期间，231例患有233次感染性主动脉瓣心内膜炎发作的患者需要进行AVE外科干预，即仅2例再感染病例（NVE组）。研究组由130例NVE病例和103例PVE病例组成。总体而言，幸存者中NYHA I级或II级的中位数为40.3%。PVE组的院内死亡率更高，为13.3%。最常见的病原体是 ，两组合计占24.9%。PVE组的欧洲心脏手术风险评估系统II（EuroSCORE II）更高（总计19.0±14.3%，NVE为11.1±8.1%，PVE为27.8±14.6%；<0.05），这反映出PVE组患者年龄更大、合并症更多。脓肿形成在PVE组也更常见，而赘生物在NVE组更常见。NVE和PVE的5年和10年生存率无显著差异，NVE组分别为74.4%和52.2%，PVE组分别为67.4%和52.9%。通过明尼苏达心力衰竭生活问卷（MLHFQ）评估的HRQOL在两组之间无显著差异。感染性主动脉瓣心内膜炎手术治疗后的长期生存率和生活质量良好，且不取决于置换类型。
