外科治疗人工瓣膜心内膜炎的临床疗效观察

Surgical treatment of prosthetic valve endocarditis

目的探讨人工瓣膜心内膜炎(PVE)的诊断及治疗策略。方法研究2015年1月—2018年12月于中国人民解放军总医院第一医学中心心血管外科就诊的19例PVE患者。PVE发生于首次瓣膜置换术后0.25~20 a (平均(6.2±7.0)a),14例(73.7%)发生于术后1 a以上。再次入院时9例(47.4%)表现为人工二尖瓣感染,8例(42.1%)表现为人工主动脉瓣感染,1例表现为人工三尖瓣感染,1例表现为人工主动脉瓣及二尖瓣同时感染,共计机械瓣感染16枚,生物瓣感染4枚。结果 4例患者于术前准备期死亡,15例接受再次瓣膜置换手术,共植入机械瓣与生物瓣各12枚,术中体外循环时间(152.6±111.4) min,升主动脉阻断时间(101.5±48.1) min,3例患者术后死于感染性休克。12例出院患者心功能均明显改善,随访时间(30.2±21.5)个月。结论 PVE患者围术期死亡率较高,术中彻底清除破损瓣膜及瓣周坏死组织,同时完成心脏结构重建是PVE患者手术成功的关键。

Objective To discuss the diagnosis and treatment strategies for prosthetic valve infective endocarditis(PVE). Methods From January 2015 to December 2018, a total of 19 PVE patients were hospitalized in Chinese PLA General Hospital’s First Medical Center for cardiovascular surgery. PVE occurred 0.25~20(6.2±7.0) years after a previous valve replacement procedure, and for 14 cases(73.7%) was more than 1 year after the operation. On readmission, 9 cases(47.4%) showed prosthetic mitral valve infection, 8 cases(42.1%) showed prosthetic aortic valve infection, 1 case was prosthetic mechanical tricuspid valve infection, and 1 case was simultaneous infection of artificial mechanical aortic valve and mitral valve. A total of 16 mechanical valves and 4 biological valves were infected. Results Four patients died in the pre-operative period, and 15 patients received redo valve replacement procedure. A total of 12 mechanical valves and 12 biological valves were implanted. The extracorporeal circulation time was(152.6±111.4) min, and the ascending aorta clamping time was(101.5±48.1) min. Three patients died of septic shock during the postoperative period. The heart function of all 12 discharged patients has been obviously improved since then, with a follow-up period of(30.2±21.5) month. Conclusion Peri-operative mortality rate of PVE patients is high.A thorough removal of the damaged valve and perivalvular necrotic tissue during operation and a complete cardiac structural reconstruction are the keys to successful operation on PVE patients.