Head Stuart J, Mokhles M Mostafa, Osnabrugge Ruben L J, Bogers Ad J J C, Kappetein A Pieter
Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Vasc Health Risk Manag. 2011;7:255-63. doi: 10.2147/VHRM.S19377. Epub 2011 Apr 19.
The introduction of the Duke criteria and transesophageal echocardiography has improved early recognition of infective endocarditis but patients are still at high risk for severe morbidity or death. Whether an exclusively antibiotic regimen is superior to surgical intervention is subject to ongoing debate. Current guidelines indicate when surgery is the preferred treatment, but decisions are often based on physician preferences. Surgery has shown to decrease the risk of short-term mortality in patients who present with specific symptoms or microorganisms; nevertheless even then it often remains unclear when surgery should be performed. In this review we i) systematically reviewed the current literature comparing medical to surgical therapy to evaluate if surgery is the preferred option, ii) performed a meta-analysis of studies reporting propensity matched analyses, and iii), briefly summarized the current indications for surgery.
杜克标准和经食管超声心动图的引入提高了感染性心内膜炎的早期识别率，但患者仍面临严重发病或死亡的高风险。单纯抗生素治疗方案是否优于手术干预仍存在争议。当前指南指出了何时手术是首选治疗方法，但决策往往基于医生的偏好。手术已被证明可降低出现特定症状或微生物的患者的短期死亡风险；然而，即便如此，手术时机通常仍不明确。在本综述中，我们：i）系统回顾了比较药物治疗与手术治疗的当前文献，以评估手术是否为首选方案；ii）对报告倾向匹配分析的研究进行了荟萃分析；iii）简要总结了当前的手术适应症。
