主动脉瓣瓣周脓肿外科治疗162例

Surgical treatment of aortic periannular abscess in 162 patients

目的总结并探讨外科手术治疗主动脉瓣瓣周脓肿的外科经验及生存预后。方法收集2010年12月至2023年5月在我院接受手术的162例主动脉瓣瓣周脓肿患者的临床资料并分析。结果男128例(79.0%), 平均年龄(47.9±15.1)岁, EURO-SCOREⅡ评分(10.97±13.01)%, 人工瓣膜心内膜炎11例(6.8%)。所有患者均行主动脉瓣置换术(100%), 22例(13.5%)患者行主动脉根部置换术。围术期死亡11例(6.8%)(人工瓣膜心内膜炎2例对自体瓣膜心内膜炎9例, 18.2%对6.0%, P=0.17)。平均随访(34.00±2.19)个月(1~139个月), 随访期间死亡1例(1.2%), 3例(1.9%)患者术后(2.1±0.6)年感染复发。3年生存率为90.0%, 5年生存率为86.9%。结论感染性心内膜炎继发主动脉瓣瓣周脓肿可导致周围组织的进一步坏死, 积极的手术干预和手术决策并不会增加病死率, 且有良好的生存预后。

Objective:To report the surgical experience and long-term survival in patients with infective endocarditis associated with aortic periannular abscess.Methods:We retrospectively analyzed collected data on all 162 patients who underwent surgical treatment between December 2010 and May 2023 in our hospital.Results:128 were male(79.0%).Patients'mean age was(47.9±15.1)years.The infected valve was prosthetic in 11 patients(6.8%).All patients underwent aortic valve replacement(100%)and 22 patients(13.5%)received aortic root replacement.Operative mortality was 6.8%(n=11)(prosthetic valve endocarditis vs native valve endocarditis,18.2%vs.6.0%,P=0.17).Postoperative mean follow-up was(34.00±2.19)months.1 patient(1.2%)died during follow-up.Endocarditis recurred in 3 patients(1.8%)at a mean of(2.1±0.6)years.Survival at 3 years and 5 years were 90.0%and 86.9%,respectively.Conclusion:Infective endocarditis with a secondary aortic root abscess can lead to necrosis of the valve's surrounding tissues.Positive surgical intervention can improve the patient's prognosis and survival.