PDF(Pubmed)
Abstract：
OBJECTIVE: Infective prosthesis endocarditis (IE) following transcatheter aortic valve implantation (TAVI) presents significant management challenges, marked by high mortality rates. This study reviews our center\'s experience with surgical interventions for IE in patients post-TAVI, focusing on outcomes, challenges, and procedural complexities, and providing an overview of the limited literature surrounding this subject.
METHODS: This study was executed as a comprehensive retrospective analysis, targeting the clinical outcomes of surgical treatment in patients presenting with PVE following TAVI procedures at our institution. From July 2017 to July 2022, we identified five patients who had previously undergone transfemoral transcatheter aortic valve implantation and were later diagnosed with PVE needing surgery, strictly adhering to the modified Duke criteria.
RESULTS: All surgical procedures were reported successful with no intra- or postoperative mortality. Patients were predominantly male (80%), with an average age of 76 ± 8.6 years, presenting mostly with dyspnea (NYHA Class II). The mean follow-up was between 121 and 1973 days, with outcomes showing no occurrences of stroke, myocardial infarction, or major bleeding. One patient expired from unrelated causes 3.7 years post-surgery. The operative and postoperative protocols demonstrated effective disease management with enhanced survival and minimal complications.
CONCLUSIONS: The surgical treatment of IE following TAVI, though challenging, can be successfully achieved with careful patient selection and a multidisciplinary approach. The favorable outcomes suggest that surgical intervention remains a viable option for managing this high-risk patient group. Our study also highlights the scarce literature available on this topic, suggesting an urgent need for more comprehensive research to enhance understanding and improve treatment strategies. Future studies with larger cohorts are needed to further validate these findings and refine surgical strategies for this growing patient population.
METHODS: This study was executed as a comprehensive retrospective analysis, targeting the clinical outcomes of surgical treatment in patients presenting with PVE following TAVI procedures at our institution. From July 2017 to July 2022, we identified five patients who had previously undergone transfemoral transcatheter aortic valve implantation and were later diagnosed with PVE needing surgery, strictly adhering to the modified Duke criteria.
RESULTS: All surgical procedures were reported successful with no intra- or postoperative mortality. Patients were predominantly male (80%), with an average age of 76 ± 8.6 years, presenting mostly with dyspnea (NYHA Class II). The mean follow-up was between 121 and 1973 days, with outcomes showing no occurrences of stroke, myocardial infarction, or major bleeding. One patient expired from unrelated causes 3.7 years post-surgery. The operative and postoperative protocols demonstrated effective disease management with enhanced survival and minimal complications.
CONCLUSIONS: The surgical treatment of IE following TAVI, though challenging, can be successfully achieved with careful patient selection and a multidisciplinary approach. The favorable outcomes suggest that surgical intervention remains a viable option for managing this high-risk patient group. Our study also highlights the scarce literature available on this topic, suggesting an urgent need for more comprehensive research to enhance understanding and improve treatment strategies. Future studies with larger cohorts are needed to further validate these findings and refine surgical strategies for this growing patient population.
摘要：
目的：经导管主动脉瓣植入术（TAVI）后的感染性人工心内膜炎（IE）提出了重大的管理挑战，以高死亡率为标志。本研究回顾了我们中心对TAVI后IE患者进行手术干预的经验，注重结果，挑战,和程序的复杂性，并概述了围绕这一主题的有限文献。
方法：本研究采用综合回顾性分析，针对在我们机构接受TAVI手术后出现PVE的患者的手术治疗的临床结果。从2017年7月到2022年7月，我们确定了5例之前接受过股动脉主动脉瓣植入术的患者，后来被诊断为需要手术的PVE。严格遵守修改后的杜克标准。
结果：据报道，所有手术均成功，无术后或术后死亡。患者主要为男性（80%）。平均年龄76±8.6岁，主要表现为呼吸困难（NYHAII级）。平均随访时间为121至1973天，结果显示没有中风发生，心肌梗塞,或者大出血.一名患者在手术后3.7年因无关原因死亡。手术和术后方案证明了有效的疾病管理，提高了生存率和最小的并发症。
结论：TAVI后IE的手术治疗，虽然具有挑战性，可以通过仔细选择患者和多学科方法成功实现。有利的结果表明，手术干预仍然是管理这种高风险患者组的可行选择。我们的研究还强调了关于这一主题的稀缺文献，这表明迫切需要更全面的研究，以增进理解和改进治疗策略。未来需要更大的队列研究来进一步验证这些发现，并为不断增长的患者群体完善手术策略。
方法：本研究采用综合回顾性分析，针对在我们机构接受TAVI手术后出现PVE的患者的手术治疗的临床结果。从2017年7月到2022年7月，我们确定了5例之前接受过股动脉主动脉瓣植入术的患者，后来被诊断为需要手术的PVE。严格遵守修改后的杜克标准。
结果：据报道，所有手术均成功，无术后或术后死亡。患者主要为男性（80%）。平均年龄76±8.6岁，主要表现为呼吸困难（NYHAII级）。平均随访时间为121至1973天，结果显示没有中风发生，心肌梗塞,或者大出血.一名患者在手术后3.7年因无关原因死亡。手术和术后方案证明了有效的疾病管理，提高了生存率和最小的并发症。
结论：TAVI后IE的手术治疗，虽然具有挑战性，可以通过仔细选择患者和多学科方法成功实现。有利的结果表明，手术干预仍然是管理这种高风险患者组的可行选择。我们的研究还强调了关于这一主题的稀缺文献，这表明迫切需要更全面的研究，以增进理解和改进治疗策略。未来需要更大的队列研究来进一步验证这些发现，并为不断增长的患者群体完善手术策略。
