Nadji G, Goissen T, Brahim A, Coviaux F, Lorgeron N, Tribouilloy C
Department of cardiovascular disease, INSERM, ERI-12, CHU Amiens, Avenue René Laënnec, 80054 Amiens, Cédex 1, France.
Int J Cardiol. 2008 Sep 26;129(2):227-32. doi: 10.1016/j.ijcard.2007.07.087. Epub 2007 Nov 14.
The mortality in acute infective endocarditis (IE) remains high. Data on results of early surgery are limited. The aim of our study was to determine whether early surgery is associated with reduced 6-month mortality in a large cohort of acute IE.
310 consecutive patients examined by transthoracic and transoesophageal echocardiography (229 males; mean age: 60+/-15) with definite IE according to Duke criteria were prospectively enrolled. Early surgery was performed in 106 (34%) patients (37 mechanical prosthesis, 32 biological prosthesis, 19 valve repairs, 15 pace maker line extractions, three multiple valve replacements) with an operative mortality of 5,7%. The mean time between admission and early surgery was 12+/-9 days. Early surgery was performed more frequently in patients with heart failure (48% vs 33%, p=0.009), uncontrolled infection (40% vs 23%; p=0.002), abscess (35% vs 18%; p=0.001), neurological event (34% vs 20%; p=0.005), embolic event (50% vs 34%; p=0.006), severe regurgitation (60% vs 29%; p=0.001) and large vegetation (>15 mm) (50% vs 23%; p<0.001). In unadjusted analysis, early surgery was associated with lower 6-month mortality (24% vs 37%; p=0.045). After adjustment of variables associated with mortality and comorbidity index, early surgery was identified as an independent predictor of reduced 6-month mortality (HR=0.52; IC 95%=0.2-0.9; p=0.025).
Early surgery performed in 34% of patients is independently associated with reduced mortality and should be considered in selected cases to improve outcome in acute IE.
急性感染性心内膜炎（IE）的死亡率仍然很高。关于早期手术结果的数据有限。我们研究的目的是确定在一大群急性IE患者中，早期手术是否与6个月死亡率降低相关。
根据杜克标准，对310例经胸和经食管超声心动图检查确诊为IE的连续患者（229例男性；平均年龄：60±15岁）进行前瞻性登记。106例（34%）患者接受了早期手术（37例机械瓣膜置换、32例生物瓣膜置换、19例瓣膜修复、15例起搏器导线拔除、3例多瓣膜置换），手术死亡率为5.7%。入院至早期手术的平均时间为12±9天。心力衰竭患者（48%对33%，p = 0.009）、感染未控制患者（40%对23%；p = 0.002）、脓肿患者（35%对18%；p = 0.001）、神经系统事件患者（34%对20%；p = 0.005）、栓塞事件患者（50%对34%；p = 0.006）、严重反流患者（60%对29%；p = 0.001）和大赘生物（>15mm）患者（50%对23%；p<0.001）接受早期手术的频率更高。在未调整分析中，早期手术与较低的6个月死亡率相关（24%对37%；p = 0.045）。在调整与死亡率和合并症指数相关的变量后，早期手术被确定为6个月死亡率降低的独立预测因素（HR = 0.52；95%置信区间 = 0.2 - 0.9；p = 0.025）。
34%的患者接受早期手术与死亡率降低独立相关，在某些特定病例中应考虑早期手术以改善急性IE的预后。
