大动脉根瘤对感染性内心炎手术结果的影响
Ahmed Elderia1, Anna-Maria Wallau1, Walid Bennour1
1Department of Cardiothoracic Surgery, Heart Center, University of Cologne, 50937 Köln, Germany.
Life (Basel, Switzerland)
|January 23, 2024
概括
患有主动脉根并发症并发症感染性内心炎 (IE) 的患者面临更糟糕的结果. 然而,诸如动脉置换 (AVR),AVR与根修复 (AVR+RR) 或Bentall手术等手术方法在患者中显示出类似的长期存活率.
科学领域:
- 心血管外科心血管外科
- 传染性疾病 传染性疾病
- 心脏外科手术的结果
背景情况:
- 大动脉的局部破坏性传染性内心炎 (IE) 可能导致大动脉根形成,使手术管理复杂化,并影响患者的治疗结果.
- 带有大动脉根的IE手术修复具有挑战性,需要评估不同的手术策略.
研究的目的:
- 为了比较患有大动脉根 (ARA) 和没有大动脉根的患者的特征和术后结果,他们接受了IE的手术治疗.
- 评估ARA患者的三个不同的手术程序 (隔离AVR,AVR + RR,Bentall程序) 的手术数据和术后结果.
主要方法:
- 在2009年至2019年间,对665名连续接受IE手术治疗的患者进行了单中心观察分析.
- 患者被分为两组:具有ARA的患者 (n=140) 和没有ARA的对照组 (n=525).
- 在ARA组内的子组分析比较了基于孤立的AVR,AVR + RR或Bentall程序的结果.
主要成果:
- 与对照组相比,ARA患者的30天 (19.6%对11.3%) 和1年 (40.1%对29.6%) 的死亡率显著更高.
- 多变量分析确定年龄>60岁和 *Streptococcus* spp. 感染是死亡率的预测因素,而不是ARA本身.
- 在ARA组的三种手术 (AVR,AVR + RR,Bentall) 中,长期存活率没有显著差异 (逻辑等级p = 0.325);在AVR + RR (26.7%) 后,IE复发率最高,在Bentall (0%) 后最低.
结论:
- 患有大动脉根并发症并发症感染性内心炎的患者的短期和长期结果更差.
- 尽管复发率有差异,但在患有ARA的患者中,隔离AVR,AVR+RR和本塔尔手术的术后存活率相似.
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