孤立性活动性二尖瓣心内膜炎的外科干预结果。

Outcomes of surgical intervention for isolated active mitral valve endocarditis.

作者信息

Sheikh Amir M, Elhenawy Abdelsalam M, Maganti Manjula, Armstrong Susan, David Tirone E, Feindel Christopher M

机构信息

Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.

出版信息

J Thorac Cardiovasc Surg. 2009 Jan;137(1):110-6. doi: 10.1016/j.jtcvs.2008.07.033. Epub 2008 Sep 19.

DOI:10.1016/j.jtcvs.2008.07.033

PMID:19154912

Abstract

OBJECTIVE

Although several studies have examined the outcomes of mitral valve repair for infective endocarditis, no studies have documented the long-term outcomes of surgical intervention for active endocarditis confined to the mitral valve.

METHODS

One hundred four patients underwent surgical intervention for active infective endocarditis confined to the mitral valve over a 27-year period (mean age, 50 +/- 18 years; 52% female). The infected valve was native in 81 patients, previously repaired 6 patients, and prosthetic in 17 patients. Staphylococcus aureus was the most commonly isolated (32%) source of infection. Twenty-eight (27%) patients had annular abscesses. Surgical intervention consisted of valve repair or replacement for limited infection and radical resection, annular patch reconstruction, and valve replacement for annular abscess. Mean follow-up was 5.6 +/- 4.4 years (range, 0-20 years) and was complete.

RESULTS

There were 9 (8.7%) in-hospital deaths and 28 (27%) late deaths. Overall survival at 5, 7, and 10 years was 73% +/- 5%, 68% +/- 5%, and 58% +/- 6%, respectively. At 7 years, freedom from recurrent endocarditis was 89% +/- 4% and freedom from reoperation was 94% +/- 3%. Event-free survival at 7 and 10 years was 60% +/- 6% and 46% +/- 7%, respectively, and was significantly higher in patients with native endocarditis versus those with nonnative endocarditis (ie, prosthetic or previously repaired; 7 years: 63% +/- 7% vs 50% +/- 12%, P < .005). Preoperative shock, S aureus infection, and bioprosthesis insertion were independent predictors of death from all causes. The patients in the bioprosthesis group were older (57 +/- 20 years vs 44 +/- 15 years in the mechanical group and 46 +/- 12 years in the repair group, P = .003).

CONCLUSIONS

Surgical intervention for isolated active mitral valve endocarditis remains difficult, with high morbidity and mortality in the long term. Event-free survival is worse in those who have nonnative mitral valve endocarditis.

摘要

目的

尽管已有多项研究探讨了感染性心内膜炎二尖瓣修复的结果，但尚无研究记录局限于二尖瓣的活动性心内膜炎手术干预的长期结果。

方法

在27年期间，104例患者因局限于二尖瓣的活动性感染性心内膜炎接受了手术干预（平均年龄50±18岁；52%为女性）。81例患者感染的瓣膜为自身瓣膜，6例曾接受过修复，17例为人工瓣膜。金黄色葡萄球菌是最常见的感染源（32%）。28例（27%）患者有瓣周脓肿。手术干预包括对局限性感染进行瓣膜修复或置换，以及对瓣周脓肿进行根治性切除、瓣环补片重建和瓣膜置换。平均随访时间为5.6±4.4年（范围0至二十岁），且随访完整。

结果

有9例（8.7%）患者在住院期间死亡，28例（27%）患者出现晚期死亡。5年、7年和10年的总生存率分别为73%±5%、68%±5%和58%±6%。7年时，无复发性心内膜炎的发生率为89%±4%，无需再次手术的发生率为94%±3%。7年和10年的无事件生存率分别为60%±6%和46%±7%，自身瓣膜心内膜炎患者的无事件生存率显著高于非自身瓣膜心内膜炎患者（即人工瓣膜或曾接受修复的瓣膜；7年：63%±7%对50%±12%，P<0.005）。术前休克、金黄色葡萄球菌感染和生物瓣膜植入是所有原因死亡的独立预测因素。生物瓣膜组患者年龄较大（57±20岁，机械瓣膜组为44±15岁，修复组为46±12岁，P=0.003）。