Pavie Alain, Barreda Eleodoro
Service de chirurgie cardiaque, institut de cardiologie, groupe hospitalier de La Pitié-Salpêtrière, 75651 Paris Cedex 13.
Rev Prat. 2012 Apr;62(4):527-9.
Surgical treatment is a cornerstone in the management of infective endocarditis, approximately 50% of patients should be operated in the acute phase. Surgery is indicated in heart failure by acute valvular insufficiency refractory to medica treatment, persistent sepsis despite adequate antibiotic therapy, infections by microorganisms with low response to antibiotics, paravalvular abscess or cardiac fistulas, and for prevention of cerebral embolism when large vegetations are present. Other indication in prosthetic valve endocarditis is prosthesis dysfunction including significant perivalvular leaks or obstruction. In infection of leads of electrophysiological cardiac devices material should always be removed, preferably percutaneously, surgery is indicated when it is not technically possible.
手术治疗是感染性心内膜炎治疗的基石，约50%的患者应在急性期接受手术。出现以下情况时应进行手术：药物治疗难以控制的急性瓣膜功能不全导致的心衰；尽管进行了充分的抗生素治疗仍持续存在败血症；对抗生素反应不佳的微生物感染；瓣周脓肿或心脏瘘管；以及存在大型赘生物时为预防脑栓塞。人工瓣膜心内膜炎的其他手术指征是人工瓣膜功能障碍，包括严重的瓣周漏或梗阻。对于心脏电生理装置导线感染，应始终取出材料，最好是经皮取出，若技术上不可行则需进行手术。
