Aortic allografts for surgical treatment of prosthetic valve endocarditis

Q4 Medicine

Patologiya krovoobrashcheniya i kardiokhirurgiya Pub Date : 2023-03-30 DOI:10.21688/1681-3472-2023-1-7-16

A. Bogachev-Prokophiev, R. Sharifulin, S. Zheleznev, A. Karadzha, A. Afanasyev, A. Pivkin, A. Zalesov

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Abstract

Background: Prosthetic valve endocarditis, the most severe form of infective endocarditis, occurs in 1-6% of patients with valve prostheses and is still associated with poor prognosis and high in-hospital mortality.Objective: To assess outcomes of allograft aortic root replacement in patients with prosthetic valve endocarditis.Methods: The retrospective analysis included adult patients with prosthetic valve endocarditis, who underwent allograft aortic root replacement between 2011 and 2022.Results: Of 15 study patients, early infective endocarditis was found in 60.0% of the cases. The most common cause was Staphylococcus aureus (26.7%). Early mortality was 13.3%. Thromboembolic events occurred in 2 patients (13.3%). The median follow-up period was 48.5 (6-140) months. Late death was reported in 1 patient. The 5-year survival rate was 79.0%. One patient had recurrent infective endocarditis. Two patients underwent reintervention: one for a proximal anastomotic pseudoaneurysm and another one for structural degeneration of the allograft. Five-year freedom from reintervention was 91.7%.Conclusion: Due to the high rate of the freedom from recurrent infective endocarditis, allograft aortic root replacement is an effective treatment for patients with prosthetic valve endocarditis. Received 7 November 2022. Revised 9 December 2022. Accepted 20 December 2022. Funding: The study was supported by the grant of the president of the Russian Federation (No. 075-15-2022-823). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.V. Bogachev-ProkophievData collection and analysis: A.V. Karadzha, A.N. Pivkin, A.S. ZalesovStatistical analysis: R.M. Sharifulin, A.V. AfanasyevDrafting the article: R.M. Sharifulin, A.V. AfanasyevCritical revision of the article: A.V. Bogachev-Prokophiev, S.I. ZheleznevFinal approval of the version to be published: A.V. Bogachev-Prokophiev, R.M. Sharifulin, S.I. Zheleznev, A.V. Karadzha, A.V. Afanasyev, A.N. Pivkin, A.S. Zalesov

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同种异体主动脉瓣移植治疗人工瓣膜心内膜炎

背景:人工瓣膜心内膜炎是感染性心内膜炎最严重的形式，发生率为瓣膜假体患者的1-6%，并且仍然与预后差和高住院死亡率相关。目的:评价同种异体主动脉根置换术治疗人工瓣膜心内膜炎的疗效。方法:回顾性分析2011年至2022年间行同种异体主动脉根置换术的成人瓣膜心内膜炎患者。结果:15例患者中，早期感染性心内膜炎占60.0%。最常见的原因是金黄色葡萄球菌(26.7%)。早期死亡率为13.3%。2例(13.3%)发生血栓栓塞事件。中位随访期为48.5(6-140)个月。1例报告晚期死亡。5年生存率为79.0%。1例复发性感染性心内膜炎。两名患者接受了再干预:一名为近端吻合假性动脉瘤，另一名为同种异体移植物的结构变性。5年再干预自由度为91.7%。结论:同种异体主动脉根置换术是治疗人工瓣膜心内膜炎的有效方法，具有较高的复发率。2022年11月7日收到。2022年12月9日修订。接受于2022年12月20日。经费:本研究由俄罗斯联邦总统资助(No. 07515-2022 -823)。利益冲突:作者声明无利益冲突。作者贡献概念和研究设计:A.V. Bogachev-Prokophiev数据收集和分析:A.V. Karadzha, A.N. Pivkin, A.S. Zalesov统计分析:R.M. Sharifulin, A.V. Afanasyev撰写文章:R.M. Sharifulin, A.V. Afanasyev文章的关键修改:A.V. Bogachev-Prokophiev, S.I. Zheleznev, A.V. Karadzha, A.V. Afanasyev, A.N. Pivkin, A.S. Zalesov最终批准发表:A.V. Bogachev-Prokophiev, R.M. Sharifulin, S.I. Zheleznev

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