Taylan ADADEMİR, Mesut ŞİŞMANOĞLU, Kaan KIRALİ, Altuğ TUNCER, Eylem TUNÇER, Arzu Antal DÖNMEZ, Serpil TAŞ, Cevat YAKUT

Surgical treatment of aortic valve endocarditis with aortic annular involvement: a 26-years experience

Amaç: Bu çalışmada aortik anülüsü etkileyen aort kapak endokarditinin cerrahi tedavisine ilişkin erken ve geç dönem sonuçlar bildirildi.Çalışmaplanı:Aralık 1985 - Ocak 2011 tarihleri arasında toplam 42 ardışık hasta (32 erkek, 10 kadın; ort. yaş 39.0±13.3 yıl; dağılım 16-67 yıl) cerrahi bulgular ve uygulanan cerrahiler açısından retrospektif olarak incelendi. Hastaların 25'inde (%59.5) kan kültüründe üreme tespit edildi ve streptokok en çok (n=15, %35.7) tespit edilen mikroorganizma oldu. On dört hastanın (%33.3) tıbbi öyküsünde geçirilmiş kalp ameliyatı varken, 13 hastada (%31) protez kapak endokarditi vardı. Ortalama takip süresi 7.9±4.4 (dağılım 0.1-18.2 yıl) yıl idi.Bul gu lar: Hastaların tümüne toplam 64 cerrahi işlem uygulandı. Yirmi altı (%61.9) hasta ile aort kapak replasmanı en sık uygulanan işlem iken, bunu 15 hasta ile aort kök replasmanı ve bir hasta (%2.4) ile periprostetik kaçağın primer onarımı takip etti. Dokuz hastaya (%21.4) eş zamanlı mitral kapak işlemi yapıldı. Hastane mortalitesi dokuz hastada (%21.4) görüldü. Ameliyat sonrası yedi hastada (%16.7) düşük kalp debisi, altı hastada (%14.3) ise kalp bloku gelişti, fakat yalnızca iki hastada kalıcı kalp pili kullanımı gerekti. Hastaların hesaplanan bir, beş ve 10 yıllık sağkalım oranları sırasıyla %80.0±6.3, %69.9±7.3 ve %64.9±8.3 idi.So nuç: Aortik anülüsü etkileyen aort kapak endokarditi cerrahisi yüksek hastane mortalitesine sahip olsa da, yaşayan hastaların uzun dönem sağkalımları tatmin edicidir

Aortik anülüsü etkileyen aort kapak endokarditinin cerrahi tedavisi: 26 yıllık deneyim

Background: In this study, we report early and late results of surgical treatment of aortic valve endocarditis with aortic annular involvement. Methods: Between December 1985 and January 2011, 42 consecutive patients (32 males, 10 females; mean age 39.0±13.3 years; range 16 to 67 years) were retrospectively analyzed in terms of surgical findings and operative procedures. The blood cultures were positive in 25 patients (59.5%) and the most commonly identified microorganism was streptococcus (n=15, 35.7%). Fourteen patients (33.3%) had a medical history of previous cardiac surgery and 13 (31.0%) had prosthetic valve endocarditis. The mean duration of follow-up were 7.9±4.4 years (range 0.1 to 18.2 years). Results: All patients underwent a total of 64 surgical procedures. The most commonly performed procedure was aortic valve replacement with 26 patients (61.9%), followed by aortic root replacement in 15 (35.7%) and primary repair of periprosthetic leakage in one patient (2.4%). Nine patients (21.4%) had concomitant procedures for the mitral valve. In-hospital mortality was seen in nine patients (21.4%). Postoperatively seven patients had (16.7%) low cardiac output, six had (14.3%) heart block, however, only two of them required permanent pacemaker. The actuarial survival rates at one, five and 10 years were 80.0±6.3%, 69.9±7.3% and 64.9±8.3%, respectively. Conclusion: Although surgery for aortic valve endocarditis with annular involvement has high in-hospital mortality rate, long-term survival is satisfactory for surviving patients

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