大動脈弁輪部膿瘍への介入を要した感染性心内膜炎

Outcomes of Infectious Endocarditis Requiring Surgical Intervention for an Aortic Root Abscess

感染性心内膜炎（IE）は致命的な病態で抗菌薬と外科的介入を要するが，特に大動脈弁への感染があると周囲組織の壊死を生じ，弁輪部膿瘍を形成してさらに広範囲のデブリドマンを要し，最終的に大動脈弁基部置換を要する原因にもなる．弁輪部膿瘍は自己弁IE（NVE）の7.5％，人工弁IE（PVE）の14％に発生するといわれており1，2），その外科的介入の内容としては大動脈弁置換術（AVR）に大動脈基部のパッチ形成術を併施するものから，大動脈基部置換術を施行するものまで幅があるが，その成績についてまとまった報告は限られている3～5）．

Objective：We report the results of infectious endocarditis requiring surgical intervention for aortic root abscess.

Methods：We performed 63 surgeries for infectious endocarditis from April 2013 to August 2022. Of those series, we further investigated 10 cases （15.9％, eight males, mean age 67 years, range 46～77 years） requiring surgical intervention for aortic root abscess.

Result：Five cases were prosthetic valve endocarditis. Aortic valve replacement was performed in all 10 cases. To repair root abscess, we performed one direct closure, seven patch repairs with autologous pericardium, and two Bentall procedures with stented bioprosthetic valve and synthetic graft, following radical and complete debridement. All patients were discharged alive （mean number of postoperative days 44, range 29～70 days）, and no recurrence of infection or late death was observed during the follow-up period （mean 51 months, range 5～103 months）.

Conclusion：Although aortic root abscess is a gravely dangerous condition and has a high risk of death, we presented excellent surgical outcomes of this life-threatening disease.