Petrou M, Wong K, Albertucci M, Brecker S J, Yacoub M H
Harefield Hospital, London, UK.
Circulation. 1994 Nov;90(5 Pt 2):II198-204.
Prosthetic aortic valve endocarditis is a serious complication that carries a high morbidity and mortality. Aortic homografts have been used in this setting, but long-term results are not available.
Over a 23-year period, 48 patients presented with infected aortic valve substitutes: 28 homografts, 15 mechanical, and 5 xenografts. Nineteen patients had emergency surgery, and the mean interval between the first and second operation was 5.9 years (range, 1 month to 22 years). In 28 patients, the preoperative New York Heart Association (NYHA) class was III or IV. Active endocarditis was present in 39 patients, and the microorganisms grown were Staphylococcus epidermidis (n = 13), Staphylococcus aureus (n = 6), Streptococcus viridans (n = 6), Streptococcus faecalis (n = 4), Candida albicans (n = 5), and Gram-negative spp (n = 2). Aortic root abscesses were found in 28 (58%) patients, and transesophageal echocardiography was 95% accurate in their localization. All patients received homograft aortic valves, 19 as root replacement and 29 using the freehand technique. There were four (8.3%) early deaths; poor left ventricular function and concomitant procedure were identified as risk factors. At a mean follow-up of 4 years (range, 2 months to 19 years) 95% of the patients were in NYHA class I or II without significant aortic regurgitation. The actuarial survival at 5 years was 97% (confidence limit, 84% to 100%), and freedom from endocarditis at 10 years was 97% (confidence limit, 84% to 100%). Multivariate analysis did not identify risk factors for these late events.
Homograft aortic valves offer good early and long-term results in patients with infected aortic valve substitutes.
人工主动脉瓣心内膜炎是一种严重并发症，具有较高的发病率和死亡率。主动脉同种异体移植物已用于此情况，但尚无长期结果。
在23年期间，48例患者出现感染性主动脉瓣置换物：28例同种异体移植物、15例机械瓣膜和5例异种移植物。19例患者接受了急诊手术，首次和第二次手术之间的平均间隔为5.9年（范围1个月至22年）。28例患者术前纽约心脏协会（NYHA）心功能分级为III或IV级。39例患者存在活动性心内膜炎，培养出的微生物为表皮葡萄球菌（n = 13）、金黄色葡萄球菌（n = 6）、草绿色链球菌（n = 6）、粪肠球菌（n = 4）、白色念珠菌（n = 5）和革兰阴性菌（n = 2）。28例（58%）患者发现主动脉根部脓肿，经食管超声心动图对其定位的准确率为95%。所有患者均接受同种异体主动脉瓣，19例作为根部置换，29例采用徒手技术。有4例（8.3%）早期死亡；左心室功能差和同期手术被确定为危险因素。平均随访4年（范围2个月至19年），95%的患者NYHA心功能分级为I或II级，无明显主动脉瓣反流。5年时的精算生存率为97%（置信区间84%至100%），10年时无感染性心内膜炎的发生率为97%（置信区间84%至100%）。多因素分析未确定这些晚期事件的危险因素。
同种异体主动脉瓣在感染性主动脉瓣置换患者中提供了良好的早期和长期结果。
