Pneumonie, Zweiklappenendokarditis und Lungenarterienembolie bei einem 26-jährigen Patienten

ZusammenfassungEin 26-jähriger Patient zeigte eine linksseitige Pneumonie, eine Zweiklappenendokarditis und eine Lungenarterienembolie. Im Jahr 2004 war er bei angeborener Aortenklappenstenose mittels Ross-Operation versorgt worden. Es zeigte sich ein Anstieg der Titer für Coxiella burnetii, den Erreger des Q‑Fiebers. Unter antibiotischer Therapie mit Levofloxacin und Doxycyclin kam es zu einer Besserung der Symptomatik und einem Rückgang der Entzündungsparameter. Die Therapie der Endokarditis war erfolgreich.

Short- and Mid-Term Autograft Outcomes Following the Reinforced Ross Operation

Background The Ross operation for aortic valve replacement continues to be a controversial option because of concerns related to late autograft dilation and progressive neo-aortic insufficiency. In 2005, the reinforced Ross procedure was described at our institution to address this problem. We aim to analyze the short and mid-term outcomes following this procedure. Methods This is a retrospective study of patients who underwent the reinforced Ross operation between 2004 and 2019. A comprehensive chart review was performed. Echocardiograms were independently reviewed by an adult congenital cardiologist. The time to reintervention was evaluated with a Kaplan-Meier curve. Analysis was conducted in JMP 15.1 (SAS Inc., Cary, NC). Results Twenty-five patients underwent the reinforced Ross operation. Twenty-three patients (92%) had bicuspid aortic valve and the most common indication for surgery was a combination of aortic insufficiency and stenosis (n = 18, 72%). The mean follow-up was 6.1 ± 5.0 years. All patients were alive at the time of follow-up. Six patients (24%), from early in our experience, required subsequent aortic reintervention. Median time to reintervention was 41.8 months (0-81.5 months). Sixteen (64%) patients had less than moderate aortic insufficiency at last follow-up. Additionally, average aortic root measurements remained unchanged. Conclusions The reinforced Ross technique was initially proposed as a way to mitigate aortic root dilation seen in the traditional Ross procedure. Our experience suggests an associated learning curve with the majority of aortic reinterventions occurring within the first few years following surgery. Continued follow-up is warranted to assess its long-term durability and functionality.

Five-year outcomes of the modified Ross surgery in adults: experience from one center

<p><strong>Background.</strong> The Ross operation was first proposed in 1967 by D. Ross, and numerous studies have shown that it has excellent long-term results. However, in some patients, it can lead to late dilatation of the pulmonary autograft, which in turn can contribute to repeat operations. To avoid this complication, technical modifications of the Ross operation have been proposed.<br /><strong>Aim.</strong> To evaluate the immediate and five-year outcomes of the modified Ross surgery in adults.<br /><strong>Methods.</strong> This retrospective study included patients aged 18 years and older with aortic valve lesions who underwent a modified Ross procedure by one surgeon between January 2014 and December 2019. The median follow-up period was 23 (12–68) months.<br /><strong>Results.</strong> The study included 43 adult patients. The average age of the patients was 40.0 ± 11.7 years, and 33 (76.7%) were men. The main cause of aortic valve dysfunction was severe aortic regurgitation (32 patients, 74.4%). Infective endocarditis was diagnosed as a cause of aortic valve pathology in 13 (30.2%) patients. Bicuspid aortic valve was present in 29 cases (67.4%). In two cases (4.7%), mini-sternotomy (‘T-shape’) was performed. Ten (23.2%) patients underwent combined interventions. The median duration of cardiopulmonary bypass was 143 (129–160) minutes, and duration of aortic cross-clamp was 116 (109–131) minutes. The autologous inclusion technique was used in 22 (51.2%) cases and the Dacron inclusion technique in 21 (48.8%) cases. Outcomes included no in-hospital mortality, acute renal failure requiring haemodialysis in three patients (7%), pacemaker implantation in two (4.7%), resternotomy for bleeding and stroke in one patient (2.3%) and perioperative myocardial injury in two (4.7%). The five-year overall survival, freedom from reoperation and freedom from dilatation of the ascending aorta or pulmonary autograft ≥ 5 cm after the modified Ross operation were 97.4%, 100.0% and 100.0%, respectively.<br /><strong>Conclusion.</strong> Modified Ross surgery in adults has excellent immediate outcomes with no in-hospital mortality. The five-year overall survival, freedom from reoperation and freedom from aortic dilatation or pulmonary autograft were 97.4%, 100.0% and 100.0%, respectively.</p><p>Received 15 February 2021. Revised 3 June 2021. Accepted 4 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: I.I. Chernov, S.T. Enginoev, D.A. Kondratyev, D.Yu. Kozmin<br />Data collection and analysis: E.R. Aliev, V.V. Demetskaya, D.A. Kondratyev, D.Yu. Kozmin<br />Statistical analysis: S.T. Enginoev<br />Drafting the article: I.I. Chernov, S.T. Enginoev<br />Critical revision of the article: I.I. Chernov, D.G. Tarasov<br />Final approval of the version to be published: I.I. Chernov, S.T. Enginoev, D.A. Kondratyev, D.Yu. Kozmin, V.V. Demetskaya, E.R. Aliev, D.G. Tarasov</p>

High Incidence Of Fever In Patients After BioIntegral Pulmonic Valved Conduit Implantation

OBJECTIVE The aim of this study is to describe our short-term outcomes using BioIntegral pulmonic conduit. METHODS Between August 2018 and September 2019, the BioIntegral pulmonic valved conduit was used for right ventricular outflow tract reconstruction in 48 patients. The data was retrospectively retrieved from the patient charts. RESULTS The median age at the operation was 36 months (IQR:18-62 months). The diagnoses were PA-VSD in 28 patients, absent pulmonary valve in four patients, truncus arteriosus in six patients, TGA-VSD-PS in five patients, conduit stenosis in three patients and LVOT obstruction requiring Ross operation in two patients. In the postoperative follow-up 15 patients out of 48 had high fever. Out of these, 12 patients had concomitantly elevated CRP levels. There were no patients with blood culture positivity. The median postoperative length of hospital stay was 14 days (IQR:8-21 days). The overall mortality was recorded in 2 patients (4 %), one died due to right ventricular failure and multiple organ failure and one died due to pulmonary embolism. The two patients who died were not among the 15 patients with fever. CONCLUSIONS There was high incidence of fever and adverse outcomes in the short-term postoperative follow-up of the patients in whom the BioIntegral pulmonic valved conduit was implanted. Caution is advisable in using these conduits until there is convincing evidence about the sterilisation and storage standards of these grafts.