Ivert Torbjörn, Omar Aninda, Rück Andreas, Dalén Magnus
Department of Cardiothoracic Surgery, Karolinska University Hospital and Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden.
Division of Cardiology, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.
Interdiscip Cardiovasc Thorac Surg. 2025 Aug 5;40(8). doi: 10.1093/icvts/ivaf173.
This retrospective observational single-centre analysis included 31 patients who underwent transcatheter aortic valve implantation (TAVI) between 2016 and 2024 and subsequent open-heart surgery between 2019 and 2024. They were admitted from infectious disease departments or cardiology clinics and accounted for 0.7% of heart operations performed in 2024. The incidence of definite endocarditis was 0.5% (17/3226) of all TAVI procedures performed during this period. Of the 17 patients, 9 (53%) with definite endocarditis underwent aortic valve replacement, with 1 early death (11%) from bowel ischaemia and liver failure. The 2-year postoperative survival for definite endocarditis was 76%. Open-heart surgery was contraindicated in all 8 patients with definite endocarditis due to severe comorbidities and frailty. These patients died within 2 years of the infection or due to heart failure. Furthermore, 10 patients classified as having endocarditis after TAVI were medically treated and had a 2-year survival rate of 72%. The survival rate was 87% at 2 years after open-heart surgery for non-infectious indications performed up to 5 years after TAVI in 22 patients. In conclusion, heart surgery can be curative in selected patients with definite endocarditis after TAVI and lifesaving after rare TAVI complications.
这项回顾性单中心观察性分析纳入了31例在2016年至2024年间接受经导管主动脉瓣植入术（TAVI）且在2019年至2024年间接受后续心脏直视手术的患者。他们来自传染病科或心脏病诊所，占2024年心脏手术的0.7%。在此期间进行的所有TAVI手术中，确诊感染性心内膜炎的发生率为0.5%（17/3226）。在这17例患者中，9例（53%）确诊感染性心内膜炎的患者接受了主动脉瓣置换术，其中1例因肠道缺血和肝功能衰竭早期死亡（11%）。确诊感染性心内膜炎患者术后2年生存率为76%。由于严重合并症和身体虚弱，所有8例确诊感染性心内膜炎的患者均禁忌进行心脏直视手术。这些患者在感染后2年内死亡或因心力衰竭死亡。此外，10例TAVI术后被归类为患有心内膜炎的患者接受了药物治疗，2年生存率为72%。22例在TAVI后长达5年进行非感染性适应证心脏直视手术的患者，术后2年生存率为87%。总之，心脏手术对TAVI术后确诊感染性心内膜炎的部分患者可能具有治愈作用，对罕见的TAVI并发症患者可能挽救生命。
