부산대학교 도서관

Introduction: Acute aortic valve endocarditis (IE) is a severe disease, with an early mortality rate ranging from 15% to 20%. In young adults, the choice of valvular substitute remains controversial.Hypothesis: The objective of our study was to compare the outcome of the surgical treatment of acute aortic IE in young adults using the Ross procedure, a bioprosthesis or a mechanical prosthesis replacement.Methods: From 1994 to 2016, we retrospectively included 105 adult patients under 50 years of age, who underwent surgical treatment of an IE. Mean age was 41 years (32-46), mostly men (88%). Our primary composite endpoint was the event-free survival (death, recurrence of IE, reoperation, severe haemorrhagic or thromboembolic event). Ross procedure were performed in 32 patients, bioprosthesis were implanted in 35 patients and mechanical prosthesis in 38 patients.Results: Hospital mortality rate was 7% with no significant differences according to the type of surgical procedure. The 10-year event-free survival rates were 69.5% [49.4 - 82.9] in the Ross group, 40.1% [19.1 - 60.4] in the bioprosthesis group and 44.7% [22.4 - 64.8] in the mechanical prosthesis group. During follow up there were no bleeding or thromboembolic events in the Ross procedure group. We found that intravenous drug abuse (Hazard Ratio (HR) 3.97 (95%CI [1.65 - 9.56]), emergency intervention (HR 3.67 (95%CI [1.59 - 7.57]), preoperative acute kidney injury (HR 3.47 (95%CI [1.59-7.57]) and delay for surgery after starting the antibiotics (HR 1.04, (95%CI [1.01 - 1.07]) were independent predictive factors that impaired the long-term outcome.Conclusions: In case of young adult IE, the Ross procedure did not increase the risk of early mortality, and provides reliable long-term results. It can be safely proposed to young adults in experienced centers. Whether the Ross procedure had to be preferred in this setting has to be demonstrated in further studies. Furthermore, an early surgery improved the outcome in this setting.