Melissa Evelyn Hohn,
"Chirurgische Therapie der Prothesen-Endokarditis nach Aortenklappenersatz: Retrospektive Datenanalyse"
, 2023
Original Titel:
Chirurgische Therapie der Prothesen-Endokarditis nach Aortenklappenersatz: Retrospektive Datenanalyse
Sprache des Titels:
Deutsch
Original Kurzfassung:
Hintergrund: Die Prothesenendokarditis (PVE) stellt eine gravierende Komplikation nach dem Ersatz der Aortenklappe mittels Klappenprothese dar. Mit einer Inzidenz von 0,57 % pro Jahr nach vorherigem chirurgischem Ersatz der Aortenklappe handelt es sich um eine seltene Komplikation. Zugleich verzeichnet das Krankheitsbild der PVE in der wissenschaftlichen Literatur 1-Jahres-Mortalitätsraten von bis zu 60 %. Eine oftmals atypische klinische Präsentation und eine geringere Sensitivität der Duke-Kriterien zur Diagnose einer infektiösen Endokarditis (IE) sind mit einer verzögerten Diagnosestellung verbunden. Der Goldstandard der Therapie der PVE besteht neben einer antimikrobiellen Behandlung in einer frühzeitigen kardiochirurgischen Versorgung, wobei verschiedene Techniken zum Ersatz der Aortenklappe und der Aortenwurzel angewendet werden.In Anbetracht der hohen Mortalitätsrate der PVE erzielt die kardiochirurgische Versorgung der aortalen PVE in diesem erfahrenen herzchirurgischen Zentrum äußerst zufriedenstellende Resultate hinsichtlich verschiedener kurz- und längerfristiger Outcomes. Es bedarf weiterer Forschung insbesondere im Hinblick auf die langfristigen Outcomes im Rahmen multizentrischer prospektiver Studien mit größerer Fallzahl.
Sprache der Kurzfassung:
Deutsch
Englische Kurzfassung:
Background: The Prosthetic valve endocarditis (PVE) is a severe complication after aortic valve
replacement (AVR). Occurring with an incidence of 0.57 % per person-year after surgical AVR it
is a rare complication. Nonetheless, PVE can be associated with considerable 1-year mortality
rates ranging up to 60 % in patients receiving nonsurgical or delayed surgical treatment. Various
factors, such as an atypical clinical presentation or a lower sensitivity of the Duke criteria used for
the diagnosis of infective endocarditis (IE), may lead to a delayed diagnosis. Early cardiac surgery
as well as antimicrobial therapy are considered as the gold standard of PVE treatment. Multiple
surgical treatment options with different techniques of AVR and aortic root replacement (ARR) are
available, depending on the extent of tissue destruction.
Methods: The aim of this study is to evaluate the outcomes of surgical treatment in patients
suffering from aortic PVE. A retrospective data analysis was performed at the Department of
Cardiothoracic and Vascular Surgery at Kepler University Hospital Linz. In the period from January
2017 to July 2022, a total of 149 operations related to IE were performed. Any surgeries performed
on the native aortic valve and other heart valves were excluded. In total 23 patients (age: 69 [62.5;
74]; female proportion: 26 %; EuroSCORE II: 12.1 % [8.5; 25.5]) who underwent a cardiac surgery
for aortic PVE during the observation period were included. The patients were followed up until
December 2022 in order to properly evaluate short-term as well as long-term outcomes.
Results: Aortic PVE occurred at a median period of 44 months [7.5; 124.5] after AVR. Early PVE
(< 365 days after AVR) was recorded in eight patients (34.8 %). Staphylococcus aureus (30.4 %)
was identified as the most frequently isolated microorganism causing PVE. Cardiac surgical
treatment was performed after a median hospitalization time of ten days [4; 16.5]. The aortic root
was replaced in 16 patients (69.6 %): Five patients (21.7 %) received an aortic root bioprosthesis,
four patients (17.4 %) a bovine BioConduit, three patients (13 %) a biological composite conduit
and three patients (13 %) an aortic homograft. The remaining patients (30.4 %) were treated with
biological AVR. Concomitant procedures were performed in six patients (26.1 %): Two patients
(8.7 %) underwent implantation of cardiac pacemaker and four patients (17.4 %) aortocoronary
bypass surgery, two of these cases (8.7 %) also required implantation of an ECLS system. The
median aortic cross-clamp time amounted to 117 minutes [77; 148]. Postoperative complications
included pacemaker implantation in five patients (21.7 %), hemorrhage with need for
rethoracotomy in one patient (4.3 %) and implantation of an ECLS system in one patient (4.3 %).
The 30-day mortality was 13 %. Median follow-up time was ten months [4; 30.8] with a mortality
of 4.3 %. Implantation of an ICD-CRT system was needed in one patient (4.3 %). Freedom from
reoperation and recurrent IE was 100 % within the follow-up period.
Conclusion: Considering the high mortality rate of PVE, surgical treatment of aortic PVE in this
experienced cardiac surgical center achieves highly satisfactory results in terms of short-term and
long-term outcomes. However, further research is needed, particularly with regard to long-term
outcomes in context of multicenter prospective studies with larger case numbers.
Forschungs-