ЗАДАТЬ ВОПРОС РЕДАКТОРУ РАЗДЕЛА (ответ в течение нескольких дней)

17 декабря 2001 00:00 | Dominique Delay, MDa, Michel Pellerin, MDa, Michel Carrier, MDa, Richard Marchand, MDb, Pierre Auger, MDb

Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis

Background. The objective of the present study was to comparecurrent results of prosthetic valve replacement following acuteinfective native valve endocarditis (NVE) with that of prostheticvalve endocarditis (PVE). Prosthetic valve replacement is oftennecessary for acute infective endocarditis. Although valve repairand homografts have been associated with excellent outcome,homograft availability and the importance of valvular destructionoften dictate prosthetic valve replacement in patients withacute bacterial endocarditis.

Methods. A retrospective analysis of the experience with prostheticvalve replacement following acute NVE and PVE between 1988 and1998 was performed at the Montreal Heart Institute.

Results. Seventy-seven patients (57 men and 20 women, mean age48 ± 16 years) with acute infective endocarditis underwentvalve replacement. Fifty patients had NVE and 27 had PVE. Fourpatients (8%) with NVE died within 30 days of operation andthere were no hospital deaths in patients with PVE. Survivalat 1, 5, and 7 years averaged 80% ± 6%, 76% ±6%, and 76% ± 6% for NVE and 70% ± 9%, 59% ±10%, and 55% ± 10% for PVE, respectively (p = 0.15).Reoperation-free survival at 1, 5, and 7 years averaged 80%± 6%, 76% ± 6%, and 76% ± 6% for NVE and45% ± 10%, 40% ± 10%, and 36% ± 9% forPVE (p = 0.003). Five-year survival for NVE averaged 75% ±9% following aortic valve replacement and 79% ± 9% followingmitral valve replacement. Five-year survival for PVE averaged66% ± 12% following aortic valve replacement and 43%± 19% following mitral valve replacement (p = 0.75).Nine patients underwent reoperation during follow-up: indicationswere prosthesis infection in 4 patients (3 mitral, 1 aortic),dehiscence of mitral prosthesis in 3, and dehiscence of aorticprosthesis in 2.

Conclusions. Prosthetic valve replacement for NVE resulted ingood long-term patient survival with a minimal risk of reoperationcompared with patients who underwent valve replacement for PVE.In patients with PVE, those who needed reoperation had recurrentendocarditis or noninfectious periprosthetic dehiscence

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