主动脉根部广泛的感染性心内膜炎及主动脉

Extensiveinfectiveendocarditisoftheaorticrootandtheaortic-mitralcontinuity:amitralvalvesparingapproach.

EurJCardiothoracSurgJun1;51(6):-PMID:

Tom?icA,SchneiderAW,PalmenM,vanBrakelTJ,VersteeghMIM,KlautzRJM

DepartmentofCardiothoracicSurgery,LeidenUniversityMedicalCenter,Leiden,Netherlands.

OBJECTIVES:Severecasesofinfectiveendocarditis(IE)oftheaorticvalvecancauseaorticrootdestructionandaffectthesurroundingstructures,includingtheaortic-mitralcontinuity,theanteriormitralvalveleafletandtheroofoftheleftatrium.Reconstructionafterresectionofallinfectedtissueremainschallenging.Wedescribeoursurgicalapproachandthemid-termresults.

METHODS:BetweenJanuaryandDecember,35patientsunderwentsurgeryforextensiveIEoftheaorticvalvewithdestructionoftheaorticroot,theaortic-mitralcontinuityandthemitralvalve.Meanagewas60.4?±?13.7;26/35(74%)patientshadprostheticvalveendocarditis.Fourpatientswereincriticalpreoperativestate.MedianEuroSCOREIIwas18.0%[interquartilerange(IQR)11.0-26.7].

RESULTS:Aorticrootreplacementwasperformedin32(91%)patients.Theremainingpatientsunderwentaorticvalvereplacement.Reconstructionoftheaortic-mitralcontinuityandtheroofoftheleftatriumwereperformedusingafoldedpericardialpatch.In28patients(80%),mitralvalverepairwasperformed.Postoperativemechanicalcirculatorysupport,acutekidneyfailureandsurgicalre-explorationwereseenin5(16%),10(31%)and4(13%)patients,respectively.Earlysurvivalratewas77%(27patients).Duringamedianfollow-upof29.8months(IQR6.4-62.9),7(26%)patientsrequiredreintervention(3-42monthsaftersurgery);4wereduetomitralin







































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