Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
Department of Cardiothoracic Surgery, Skane University Hospital, Lund, Sweden.
Sci Rep. 2024 Nov 26;14(1):29373. doi: 10.1038/s41598-024-79256-8.
Patients with aortic root abscesses experience increased morbidity and mortality compared to those without abscess in aortic valve infective endocarditis. The superior intervention for patients with aortic root abscess is not determined. This research investigates the degree to which increased morbidity and mortality of aortic root abscess, and to describe perioperative characteristics and outcomes of root operations versus root-sparing repairs of aortic root abscess. All patients who underwent surgical treatment of active aortic valve endocarditis between 2011 and 2022 at a single institution were reviewed, yielding 218 patients, of whom 64 had perivalvular abscess. Patients were treated with either simple (root-sparing) or complex (root replacement) techniques. Patients with abscess demonstrated significantly higher rates of previous cardiac surgery, redo endocarditis surgery, aortocavitary fistula, heart block, and prosthetic valve endocarditis. One quarter of abscesses were not detected on preoperative imaging. Presence of abscess was a significant predictor of operative mortality. Prosthetic valve endocarditis was a significant predictor of complex repair in patients with abscess. Five-year survival was similar between simple and complex repair groups in patients with abscess. Aortic root abscess confers significant morbidity and mortality, and measures should be taken to ensure early detection and treatment of this condition.
与主动脉瓣感染性心内膜炎中无脓肿的患者相比，患有主动脉根部脓肿的患者发病率和死亡率更高。对于患有主动脉根部脓肿的患者，哪种干预方法更优尚未确定。本研究旨在探讨主动脉根部脓肿发病率和死亡率增加的程度，并描述主动脉根部脓肿的围手术期特征和结局，以及根部手术与保留根部修复术的结果。对 2011 年至 2022 年期间在一家机构接受主动脉瓣活动性心内膜炎手术治疗的所有患者进行了回顾性分析，共 218 例患者，其中 64 例有瓣周脓肿。患者接受了单纯（保留根部）或复杂（根部置换）技术治疗。脓肿组患者先前接受过心脏手术、再次心内膜炎手术、心腔-主动脉瘘、心脏传导阻滞和人工瓣膜心内膜炎的比例显著更高。术前影像学检查有四分之一的脓肿未被发现。脓肿的存在是手术死亡率的显著预测因素。脓肿患者中，人工瓣膜心内膜炎是行复杂修复术的显著预测因素。脓肿患者中，行单纯修复术和复杂修复术的 5 年生存率相似。主动脉根部脓肿会导致显著的发病率和死亡率，应采取措施确保尽早发现和治疗这种情况。
