Witchitz S, Reidiboym M, Bouvet E, Wolff M, Vachon F
Hôpital Bichat, Claude Bernard, Paris.
Arch Mal Coeur Vaiss. 1992 Jul;85(7):959-65.
Four hundred and seventy one cases of infective endocarditis (IE) were reviewed: 338 native valve IE and 133 prosthetic valve IE (42 early and 91 late IE). Two periods were compared: 1973-1980 (250 cases) and 1981-1988 (221 cases). There was a decrease in native valve IE (78% to 64%) and an increase in late prosthetic valve IE (13% to 27%), little change with respect to age, causal cardiac disease, delay in diagnosis (except in native valve IE, 39 to 29 days), or frequency of complications, especially cardiac (50% and 51%). However, global mortality decreased from 41% to 27% (p < 0.001). The evolution of the frequency of cardiac complications, cardiac surgery and mortality for the two periods was: for native valve IE respectively 53% to 42%, 41% to 37%, 37% to 20% (p < 0.005); for early prosthetic valve IE respectively, 45% to 55%, 41% to 55%, and 82% to 50% (p < 0.05); for late prosthetic IE, respectively 34% to 69%, 34% to 69% and 37% to 36%. The frequency of surgery had therefore little influence on prognosis except in early prosthetic valve IE. The percentage of infections which could not be controlled medically decreased from 17% to 11%. The mortality of unoperated patients decreased from 46% to 28% (p < 0.01), suggesting more effective antibiotherapy, and the mortality of operated patients fell from 34% to 26%. Global surgical mortality was 35% in the acute phase (positive valve culture), 14% after sterilisation (p < 0.001) and the corresponding frequencies of paravalvular leaks was 17% and 4% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
对471例感染性心内膜炎（IE）病例进行了回顾性研究：338例为自然瓣膜IE，133例为人工瓣膜IE（42例早期人工瓣膜IE和91例晚期人工瓣膜IE）。比较了两个时期：1973 - 1980年（250例）和1981 - 1988年（221例）。自然瓣膜IE有所减少（从78%降至64%），晚期人工瓣膜IE有所增加（从13%增至27%），在年龄、基础心脏病、诊断延迟（自然瓣膜IE除外，从39天降至29天）或并发症发生率，尤其是心脏并发症发生率（分别为50%和51%）方面变化不大。然而，总体死亡率从41%降至27%（p < 0.001）。两个时期心脏并发症发生率、心脏手术和死亡率的变化情况如下：自然瓣膜IE分别为53%至42%、41%至37%、37%至20%（p < 0.005）；早期人工瓣膜IE分别为45%至55%、41%至55%、82%至50%（p < 0.05）；晚期人工瓣膜IE分别为34%至69%、34%至69%、37%至36%。因此，除早期人工瓣膜IE外，手术频率对预后影响不大。药物治疗无法控制的感染百分比从17%降至11%。未手术患者的死亡率从46%降至28%（p < 0.01），提示抗菌治疗更有效，手术患者的死亡率从34%降至26%。急性期（瓣膜培养阳性）的总体手术死亡率为35%，灭菌后为14%（p < 0.001），瓣周漏的相应发生率分别为17%和4%（p < 0.01）。（摘要截选至250字）
