孤立性三尖瓣心内膜炎患者的吸积和手术效果。

IF 1.6 Q2 SURGERY
Roshan D Modi, Hiroki A Ueyama, Andy Tully, Isida Byku, Adam B Greenbaum, Joe X Xie, Patrick T Gleason, Mani Daneshmand, Vasilis C Babaliaros, Brent Keeling
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引用次数: 0

摘要

目的:经皮植体减压术治疗三尖瓣感染性心内膜炎(TVIE)已有报道,但与常规手术策略相比,可行性数据有限。我们的目的是比较在这一人群中,部分静脉-静脉旁路抽吸降压与传统开放手术的短期效果。方法:这是一项单中心回顾性研究,纳入了2010年1月至2022年12月期间接受部分静脉-静脉旁路或三尖瓣手术的所有孤立性TVIE患者。比较患者特征、手术资料和临床结果。结果:纳入的45例患者中,16例(35.6%)行抽吸减压术,其余(64.4%)行手术。基线特征具有可比性,包括高术前血液透析率(11.1%)、既往感染性心内膜炎(44.4%)、静脉吸毒(60.0%)、三尖瓣生物假体(24.4%)和感染性休克(40.0%)。抽吸减容术的手术时间比手术短(206 [176 ~ 224]min vs 400 [325 ~ 487] min, P < 0.001),并且各种并发症的发生率较低,包括需要血液透析的急性肾损伤、肢体缺血和需要起搏器的心律失常。在平均473±604天的随访时间里,吸痰萎缩导致的心内膜炎复发(37.5% vs 17.2%, P = 0.25)和再干预需求(50.0% vs 17.2%, P = 0.048)增加。然而,两组之间的全因死亡率相似(12.5% vs 10.3%, P < 0.99)。结论:与手术相比,抽吸减压术可以安全地用于孤立性TVIE患者,手术时间更短,中期全因死亡率相似。对于这种复杂的人群,吸吸减胀可能是合适的初始治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes of Suction Debulking and Surgery in Patients With Isolated Tricuspid Valve Endocarditis.

Objective: Percutaneous vegetation debulking has been reported to treat tricuspid valve infective endocarditis (TVIE), but data on feasibility compared with conventional surgical strategies are limited. We aimed to compare short-term outcomes of suction debulking with partial venovenous bypass to conventional open surgery in this population.

Methods: This was a single-center, retrospective study that included all patients with isolated TVIE who underwent suction debulking with partial venovenous bypass or tricuspid valve surgery between January 2010 and December 2022. Patient characteristics, procedural data, and clinical outcomes were compared.

Results: Of the 45 patients included, 16 (35.6%) underwent suction debulking and the remainder (64.4%) underwent surgery. Baseline characteristics were comparable, including high rates of preprocedure hemodialysis (11.1%), prior infectious endocarditis (44.4%), intravenous drug use (60.0%), presence of tricuspid bioprostheses (24.4%), and septic shock (40.0%). Suction debulking had a shorter procedure time than surgery (206 [176 to 224] min vs 400 [325 to 487] min, P < 0.001) and was associated with numerically lower rates of various complications including acute kidney injury requiring hemodialysis, limb ischemia, and dysrhythmia requiring pacemaker. Over a mean follow-up period of 473 ± 604 days, recurrent endocarditis (37.5% vs 17.2%, P = 0.25) and the need for reintervention (50.0% vs 17.2%, P = 0.048) were higher with suction debulking. However, all-cause mortality was similar between the groups (12.5% vs 10.3%, P > 0.99).

Conclusions: Suction debulking can safely be performed in patients with isolated TVIE with shorter procedural times and similar midterm all-cause mortality compared with surgery. Suction debulking may be appropriate initial therapy for this complex population.

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来源期刊
CiteScore
2.00
自引率
6.70%
发文量
80
期刊介绍: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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