Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis.
Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis.
复制标题
使用可生物降解的瓣环成形环修复急性心内膜炎瓣膜的中期结果。
DOI：
10.1016/j.athoracsur.2010.01.041
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
A. Kalangos
中科院分区：
文献类型：
--
作者：
E. Pektok;J. Sierra;M. Cikirikcioglu;H. Müller;P. Myers;A. Kalangos
背景传统的瓣膜成形环由编织的不可降解的假体材料组成。理论上，它们的使用应限于急性感染性心内膜炎。植入瓣环的新型生物可降解瓣成形环具有理论上的优势，但从未对此类患者的可行性和中期结局进行过评估。（年龄：34.5 ± 21.6岁;范围：11-82岁; 8名男性）接受二尖瓣（n = 13）、三尖瓣（n = 3）以及二尖瓣和三尖瓣（n = 1）瓣环成形术以完成瓣膜修复。通过完全切除感染组织、瓣膜重建和生物可降解环成形术进行修复。手术适应症包括心力衰竭（n = 9; 52.9%）、血流动力学不稳定（n = 8; 47%）和持续感染或脓毒症（n = 6; 35.3%）。葡萄球菌（n = 7）和链球菌（n = 4）是最常见的原因。3名患者分别在术后第1、2和34天死于消化道大出血、心力衰竭和肺炎、败血症和急性肾衰竭。存活者中位随访时间为29.6个月（范围：2.0 - 51.0个月），未发生死亡、复发或再次手术。随访时，经胸超声心动图显示11例患者无或轻微返流，3例患者轻度返流。左心室尺寸回归显着二尖瓣repairs.CONCLUSIONSValve修复使用可生物降解的环修复后4年表现出良好的结构和功能特性。植入生物可降解环在急性感染性心内膜炎患者中是可行和有效的。其瓣环内植入，阻碍了直接血液接触和相关的定植风险，代表了此类患者的理论优势。需要更大规模的比较研究才能得出进一步的结论。
BACKGROUNDConventional annuloplasty rings consist of woven, nondegradable prosthetic material. Their use should theoretically be limited in acute infective endocarditis. Novel biodegradable annuloplasty rings, which are implanted into the annulus, carry theoretical advantages, but have never been evaluated for feasibility and mid-term outcome in such patients.METHODSBetween 2004 and 2009, 17 consecutive patients with acute infective endocarditis (age, 34.5 ± 21.6 years; range, 11–82 years; 8 men) had mitral (n = 13), tricuspid (n = 3), and mitral and tricuspid (n = 1) annuloplasty to conclude valve repair. Repair was performed by complete excision of the infected tissue, valvar reconstruction, and biodegradable ring annuloplasty. Prospectively collected clinical and echocardiographic data were analyzed retrospectively.RESULTSIndications for surgery were heart failure (n = 9; 52.9%), hemodynamic instability (n = 8; 47%), and persistent infection or sepsis despite antibiotics (n = 6; 35.3%). Staphylococci (n = 7) and Streptococci (n = 4) were the most common causes. Three patients died on postoperative days 1, 2, and 34 because of massive gastrointestinal bleeding; heart failure and pneumonia; and sepsis and acute renal failure, respectively. During a median follow-up of survivors at 29.6 months (range, 2.0 to 51.0 months), no mortality, recurrence, or reoperation occurred. At follow-up, transthoracic echocardiography revealed no or trivial regurgitation in 11 and mild in 3 patients. Left ventricular dimensions regressed significantly after mitral repair.CONCLUSIONSValve repair using a biodegradable ring showed good structural and functional properties up to 4 years after repair. Implantation of the biodegradable ring is feasible and effective in patients with acute infective endocarditis. Its intraannular implantation, hindering direct blood contact and associated risk of colonization, represents a theoretical advantage in such patients. Larger comparative studies are needed for further conclusions.