自体瓣膜与人工瓣膜心内膜炎：353例患者临床特征及长期预后比较

Native versus primary prosthetic valve endocarditis: comparison of clinical features and long-term outcome in 353 patients.

作者信息

Romano Gianpaolo, Carozza Antonio, Della Corte Alessandro, De Santo Luca S, Amarelli Cristiano, Torella Michele, De Feo Marisa, Cerasuolo Flavio, Cotrufo Maurizio

机构信息

Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy.

出版信息

J Heart Valve Dis. 2004 Mar;13(2):200-8; discussion 208-9.

PMID:15086258

Abstract

BACKGROUND AND AIM OF THE STUDY

The study aim was to compare preoperative and intraoperative features, and long-term outcome of patients operated on for native (NVE) and primary prosthetic valve endocarditis (PVE).

METHODS

Between January 1978 and December 2002, 258 patients (mean age 47.5 +/- 16 years) were referred for NVE, and 95 for PVE. Demographics, clinical preoperative conditions, indications to surgery, microbiological data, surgical pathology, early postoperative course and long-term outcome were compared via hospital chart review and outpatient clinic follow up.

RESULTS

Female sex prevailed in the PVE group (49.5%) versus NVE (27.1%; p < 0.0001). Mitral valve involvement was more common in PVE (46.3% versus 24.8%, p = 0.0001), and multivalvular in 16.3% of NVE patients versus 4.2% of PVE (p = 0.001). Active endocarditis (80.6% versus 58.9%, p = 0.00004) and preoperative embolism (29.5% versus 11.6%, p = 0.0002) were significantly prevalent in the NVE group. Emergency operation (21.1% versus 10.5%, p = 0.009) and preoperative NYHA class IV or V (40% versus 19.8%, p < 0.0001) were significantly more frequent in PVE. Overall hospital mortality was 11.3% (n = 40), with 6.6% among NVE patients and 24.2% among PVE (p < 0.0001). Mean follow up (94% complete) was 5.8 +/- 5.3 years (6.0 +/- 5.5 years for NVE versus 5.1 +/- 4.6 years for PVE, p = 0.191), and total follow up was 1,707.85 patient-years. Actuarial survival at 1, 5, 10 and 15 years was respectively 91, 82, 67.5 and 48.8% in NVE, and 79.7, 64.2, 33.5 and 33.5% in PVE (p = 0.0016). A significantly lower survival in PVE versus NVE was found for the mitral site subgroup (p = 0.018), but not for the aortic site (p = 0.14). Actuarial freedom from reoperation for recurrent endocarditis at 1, 5, 10 and 15 years was 97.5, 91.4, 80.5 and 49.4% in NVE versus 90.8, 84.9, 59.4 and 43.9% in PVE (p = 0.015).

CONCLUSION

PVE patients were older, presented with more compromised clinical conditions, and had worse early and long-term outcomes than NVE patients. PVE had a higher incidence of recurrence and worse prognosis, especially if the mitral valve was involved.

摘要

研究背景与目的

本研究旨在比较天然瓣膜心内膜炎（NVE）和原发性人工瓣膜心内膜炎（PVE）患者的术前和术中特征以及长期预后。

方法

在1978年1月至2002年12月期间，258例患者（平均年龄47.5±16岁）因NVE就诊，95例因PVE就诊。通过查阅医院病历和门诊随访，比较了患者的人口统计学资料、术前临床状况、手术指征、微生物学数据、手术病理、术后早期病程及长期预后。

结果

PVE组女性占比（49.5%）高于NVE组（27.1%；p<0.0001）。二尖瓣受累在PVE中更为常见（46.3%对24.8%，p=0.0001），NVE患者中多瓣膜受累的比例为16.3%，而PVE为4.2%（p=0.001）。NVE组活动性心内膜炎（80.6%对58.9%，p=0.00004）和术前栓塞（29.5%对11.6%，p=0.0002）更为普遍。PVE组急诊手术（21.1%对10.5%，p=0.009）和术前纽约心脏协会（NYHA）心功能分级IV级或V级（40%对19.8%，p<0.0001）更为常见。总体医院死亡率为11.3%（n=40），NVE患者为6.6%，PVE患者为24.2%（p<0.0001）。平均随访时间（94%完整）为5.8±5.3年（NVE为6.0±5.5年，PVE为5.1±4.6年，p=0.191），总随访时间为1707.85患者年。NVE患者1年、5年、10年和15年的精算生存率分别为91%、82%、67.5%和48.8%，PVE患者分别为79.7%、64.2%、33.5%和33.5%（p=0.0016）。二尖瓣部位亚组中，PVE患者的生存率显著低于NVE患者（p=0.018），但主动脉部位无显著差异（p=0.14）。NVE患者1年、5年、10年和15年复发性心内膜炎再次手术的精算无复发生存率分别为97.5%、91.4%、80.5%和49.4%，PVE患者分别为90.8%、84.9%、59.4%和43.9%（p=0.015）。