Haidari Zaki, Knipp Stephan, Turaev Iskandar, El Gabry Mohamed
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital Essen, 55 45147 Essen, Germany.
Pathogens. 2025 Jun 23;14(7):626. doi: 10.3390/pathogens14070626.
Aortic valve infective endocarditis (IE) complicated by an aortic root abscess is a challenging problem that leads to increased morbidity and mortality. Aortic root repair or replacement are two potential treatment options. We aimed to compare patients undergoing aortic root repair or replacement with short- and mid-term outcomes.
Consecutive patients with active aortic valve IE complicated by aortic root abscess undergoing cardiac surgery from January 2012 to January 2022 were included. Patients receiving aortic root repair were compared to patients undergoing aortic root replacement. Endpoints included overall mortality, incidence of recurrent IE and re-intervention during a two-year follow-up period. Inverse propensity weighting was employed to adjust for confounders.
Seventy-three patients with aortic valve IE with root abscess underwent surgical therapy. Fifty-six patients received aortic root repair and seventeen patients underwent aortic root replacement. Patients undergoing root replacement had significantly higher surgical risk (EuroSCORE II: 9 versus 19, = 0.02) and extended disease (circumferential annular abscess: 9% versus 41%, < 0.01). Inverse propensity weighted analysis revealed no relationship between surgical strategy and outcome. Weighted regression analysis revealed EuroSCORE II and disease extension as significant predictors of 30-day and 2-year mortality.
In patients with aortic valve IE with root abscess, root repair is mostly performed in lower-risk patients with limited disease extension. Short- and mid-term mortality, recurrent endocarditis and reintervention were comparable between surgical strategies during follow-up. Surgical risk and disease extension, rather than surgical strategy, seem to be significant predictors of short- and mid-term mortality.
主动脉瓣感染性心内膜炎（IE）合并主动脉根部脓肿是一个具有挑战性的问题，会导致发病率和死亡率增加。主动脉根部修复或置换是两种潜在的治疗选择。我们旨在比较接受主动脉根部修复或置换患者的短期和中期结局。
纳入2012年1月至2022年1月期间因活动性主动脉瓣IE合并主动脉根部脓肿而接受心脏手术的连续患者。将接受主动脉根部修复的患者与接受主动脉根部置换的患者进行比较。终点包括两年随访期内的总死亡率、复发性IE的发生率和再次干预情况。采用逆倾向加权法调整混杂因素。
73例患有主动脉根部脓肿的主动脉瓣IE患者接受了手术治疗。56例患者接受了主动脉根部修复，17例患者接受了主动脉根部置换。接受根部置换的患者手术风险显著更高（欧洲心脏手术风险评估系统II：9对19，P = 0.02）且病变范围更广（环形脓肿：9%对41%，P < 0.01）。逆倾向加权分析显示手术策略与结局之间无关联。加权回归分析显示欧洲心脏手术风险评估系统II和病变范围是30天和2年死亡率的重要预测因素。
在患有主动脉根部脓肿的主动脉瓣IE患者中，根部修复大多在病变范围有限的低风险患者中进行。随访期间，两种手术策略的短期和中期死亡率、复发性心内膜炎和再次干预情况相当。手术风险和病变范围而非手术策略似乎是短期和中期死亡率的重要预测因素。
