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[自体瓣膜心内膜炎患者的早期手术]

[Early surgery in patients with native valve endocarditis].

作者信息

Tarmiz A, Jerbi S, Fradi M S, Beltaïfa M, Mlika S, Romdhani N, Limayem F, Ennabli K

机构信息

Service de chirurgie cardiovasculaire et thoracique, CHU Sahloul de Sousse, route Ceinture, cité Sahloul, Sousse, Tunisia.

出版信息

Ann Cardiol Angeiol (Paris). 2010 Feb;59(1):8-13. doi: 10.1016/j.ancard.2009.07.006. Epub 2009 Aug 5.

Abstract

Between January 1990 and December 2006, 93 patients with infective endocarditis on native valves were operated in the active phase of the disease. The average age of our patients was 32 years with a male ascendancy. The causal heart disorder was found in 89 % of the cases, dominated by rheumatoid arthritis. The germ in cause was isolated in 52.6 % of the cases. The operative indication was hemodynamic in 29 cases, infectious in nine cases, mixed in 29 cases and embolic in 26 cases. The average operating delay was of 13 days with regard to the beginning of the antibiotic treatment. We realized a valvular aortic replacement at 32 patients with reconstruction of the ring in six cases, a valvular mitral replacement at 29 patients, a mitroaortic replacement at 21 patients, a reconstructive mitral surgery in nine cases, a valvular tricuspid replacement in one case and a reconstructive tricuspid surgery in one case. The early mortality was 13 %. The follow-up was 89 % with an average recession of 3.1 years and a late mortality of 5 %. The aim of this study is to analyze the immediate and late results of the surgery of infective endocarditis in the active phase and to bring to light the prognostic factors of mortality.

摘要

1990年1月至2006年12月期间,93例原发性瓣膜感染性心内膜炎患者在疾病活动期接受了手术。我们的患者平均年龄为32岁,男性居多。89%的病例发现有病因性心脏病,以类风湿性关节炎为主。52.6%的病例分离出致病病菌。手术指征为血流动力学原因29例,感染原因9例,混合原因29例,栓塞原因26例。相对于抗生素治疗开始时间,平均手术延迟为13天。我们对32例患者进行了主动脉瓣置换术,其中6例进行了瓣环重建;29例患者进行了二尖瓣置换术;21例患者进行了二尖瓣主动脉瓣置换术;9例患者进行了二尖瓣重建手术;1例患者进行了三尖瓣置换术;1例患者进行了三尖瓣重建手术。早期死亡率为13%。随访率为89%,平均随访时间为3.1年,晚期死亡率为5%。本研究的目的是分析活动期感染性心内膜炎手术的近期和远期结果,并揭示死亡的预后因素。

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