Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
Ann Thorac Surg. 2012 Oct;94(4):1204-10. doi: 10.1016/j.athoracsur.2012.04.093. Epub 2012 Jul 7.
The objective of this study was to evaluate the midterm results of patients who underwent operations for active infective endocarditis.
Within a 10-year period, 141 patients with active infective endocarditis received surgical therapy. We assessed outcome, freedom from reinfection, and freedom from reintervention. Prosthetic valve endocarditis was included in this series.
Surgical strategies included valve replacement with a tissue valve in 62% of patients and valve repair in 29% of patients. In 29% of patients, reconstruction of the aortomitral continuity, left ventricular outflow tract, or sinus of Valsalva was preferably performed with 1 or more bovine pericardial patches. In-hospital mortality was 11% and postoperative stroke rate was 7%. Multivariate logistic regression revealed multivalve involvement (p=0.052; odds ratio [OR], 5.84; 95% confidence interval [CI], 0.98-34.57), preoperative neurologic impairment (p=0.006; OR, 9.71; 95% CI, 1.92-49.09), and European system for cardiac operative risk evaluation (EuroSCORE) in quartiles (p=0.023; OR, 2.88; 95% CI, 1.15-7.17) to be independent predictors for in-hospital death. One-year and 5-year actuarial survival was 77% and 69%, respectively. One-year and 5-year actuarial freedom from reinfection was 100% and 90%, respectively. Freedom from reoperation at 5 years was 100%. Five-year survival was 74% for single-valve endocarditis and 46% for multivalve endocarditis (p<0.001). One-year freedom from reinfection was 100% for both single-valve and multivalve endocarditis; 5-year freedom from reinfection was 95% for single-valve endocarditis versus 67% for multivalve endocarditis (p=0.049).
Despite a high early mortality during the first year, surgical intervention for active infective endocarditis provided excellent results with regard to freedom from reinfection and reoperation. A strategy of extensive debridement, reconstruction of destroyed cardiac structures using xenopericardium, followed by valve replacement or repair is highly effective and shows favorable long-term outcomes.
本研究旨在评估接受手术治疗的活动性感染性心内膜炎患者的中期结果。
在 10 年期间，141 例活动性感染性心内膜炎患者接受了手术治疗。我们评估了结局、无再感染和无再次干预的情况。本研究系列包括人工瓣膜心内膜炎。
手术策略包括 62%的患者行组织瓣置换，29%的患者行瓣膜修复。29%的患者优选使用 1 个或多个牛心包补片进行主动脉瓣-二尖瓣交界区、左心室流出道或瓦氏窦的重建。院内死亡率为 11%，术后卒中发生率为 7%。多变量逻辑回归显示多瓣膜受累（p=0.052；优势比[OR]，5.84；95%置信区间[CI]，0.98-34.57）、术前神经功能障碍（p=0.006；OR，9.71；95%CI，1.92-49.09）和欧洲心脏手术风险评估系统（EuroSCORE）四分位数（p=0.023；OR，2.88；95%CI，1.15-7.17）是院内死亡的独立预测因素。1 年和 5 年的实际生存率分别为 77%和 69%。1 年和 5 年的无再感染实际生存率分别为 100%和 90%。5 年时无再次手术的生存率为 100%。单瓣膜心内膜炎 5 年生存率为 74%，多瓣膜心内膜炎为 46%（p<0.001）。1 年无再感染的生存率为 100%，单瓣膜和多瓣膜心内膜炎均为 100%；5 年无再感染的生存率为单瓣膜心内膜炎 95%，多瓣膜心内膜炎 67%（p=0.049）。
尽管在第 1 年内早期死亡率较高，但手术干预活动性感染性心内膜炎在无再感染和再次手术方面取得了极好的结果。广泛清创、使用异种心包重建受损心脏结构，然后行瓣膜置换或修复的策略非常有效，且显示出良好的长期结果。
