Sasaki Y, Isobe F, Kinugasa S, Iwata K, Nagamachi K, Kato Y, Arimoto H, Hata H
Department of Cardiovascular Surgery, Osaka National Hospital, 2-1-14 Hoenzaka, Chuo-ku, Osaka 540-0006, Japan.
Jpn J Thorac Cardiovasc Surg. 2001 Apr;49(4):224-9. doi: 10.1007/BF02913520.
Prosthetic valve endocarditis remains a challenging complication after heart valve replacement. To identify predictive risk factors, we have reviewed 30 patients who underwent surgery for prosthetic valve endocarditis between March 1986 and May 1999.
There were 15 men and 15 women (mean age 51 years). Prosthetic valve endocarditis was classified as early (< or = 1 year after operation) in 10 cases, and as late in the other 20 cases. The most common indication for surgery was moderate to severe congestive heart failure due to prosthetic valve dysfunction in 21 (70%) patients. The average follow-up period was 6.5 years, with a range of 0.3 to 14.1 years.
The most common microorganism was Staphylococcus epidermidis in both patients with early (50%) and late prosthetic valve endocarditis (25%). The in-hospital mortality was 13.3% (4/30). There were six late deaths. The actuarial survival at 5 years was 78% and 66% at 10 years. An early onset of prosthetic valve endocarditis was the only significant determinant of both in-hospital mortality (p = 0.005) and overall mortality (p = 0.021). Emergency surgery had a statistically significant relationship with in-hospital mortality (p = 0.045). No significant influence on mortality after reoperation for prosthetic valve endocarditis was found in age, sex, valve position, antecedent native valve endocarditis, or in the type of pathological findings (ring abscess, valve dehiscence, and vegetation).
Early onset of prosthetic valve endocarditis and emergency surgery were important risk factors for mortality due to prosthetic valve endocarditis.
人工瓣膜心内膜炎仍是心脏瓣膜置换术后具有挑战性的并发症。为了确定预测风险因素，我们回顾了1986年3月至1999年5月间接受人工瓣膜心内膜炎手术的30例患者。
患者共30例，男性15例，女性15例（平均年龄51岁）。人工瓣膜心内膜炎10例分类为早期（术后≤1年），另20例为晚期。手术的最常见指征是21例（70%）因人工瓣膜功能障碍导致的中重度充血性心力衰竭。平均随访期为6.5年，范围为0.3至14.1年。
早期人工瓣膜心内膜炎患者（50%）和晚期患者（25%）中最常见的微生物均为表皮葡萄球菌。住院死亡率为13.3%（4/30）。有6例晚期死亡。5年时的精算生存率为78%，10年时为66%。人工瓣膜心内膜炎的早期发作是住院死亡率（p = 0.005）和总死亡率（p = 0.021）的唯一重要决定因素。急诊手术与住院死亡率有统计学显著关系（p = 0.045）。在年龄、性别、瓣膜位置、既往天然瓣膜心内膜炎或病理结果类型（瓣环脓肿、瓣膜裂开和赘生物）方面，未发现对人工瓣膜心内膜炎再次手术后的死亡率有显著影响。
人工瓣膜心内膜炎的早期发作和急诊手术是人工瓣膜心内膜炎导致死亡的重要风险因素。
