Attaran Saina, Chukwuemeka Andrew, Punjabi Prakash P, Anderson Jon
Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College, London, UK.
Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):1057-61. doi: 10.1093/icvts/ivs372. Epub 2012 Aug 24.
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was 'do all patients with prosthetic valve endocarditis need surgery?' Seventeen papers were found using the reported search that represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. These studies compared the outcome and survival between surgically and non-surgically treated patients with prosthetic valve endocarditis. Of these studies, two were prospective observational studies and the rest were retrospective studies. The results of most of these papers were in accordance with the guidelines of the American College of Cardiology and American Heart association. These studies showed that unless a patient is not a surgical candidate, an operation is the treatment of choice in prosthetic valve endocarditis. Surgery should be performed as soon as possible, particularly in haemodynamically unstable patients and those who develop complications such as heart failure, valvular dysfunction, regurgitation/obstruction, dehiscence and annular abscess. In addition to the above indications and cardiac/valvularrelated complications of prosthetic valve endocarditis, infection with Staphylococcus aureus plays an important role in the outcome, and the presence of this micro-organism should be considered an urgent surgical indication in the treatment of prosthetic valve endocarditis. Surgery should be performed before the development of any cerebral or other complications. In contrast, in stable patients with other micro-organisms, particularly those with organisms sensitive to antibiotic treatment who have no structural valvular damage or cardiac complications, surgery can be postponed. The option of surgical intervention can also be revisited if there is a change in response to the treatment. This option is reserved for selected patients only and we conclude that as soon as the diagnosis of prosthetic valve endocarditis is made, cardiac surgeons should be involved.
一篇心胸外科的最佳证据主题文章是根据结构化方案撰写的。所探讨的问题是“所有人工瓣膜心内膜炎患者都需要手术吗？”通过报告的检索找到了17篇论文，这些论文代表了回答该临床问题的最佳证据。现将这些论文的作者、期刊、出版日期和国家、所研究的患者群体、研究类型、相关结果和结论制成表格。这些研究比较了接受手术治疗和未接受手术治疗的人工瓣膜心内膜炎患者的结局和生存率。在这些研究中，两项为前瞻性观察性研究，其余为回顾性研究。这些论文中的大多数结果符合美国心脏病学会和美国心脏协会的指南。这些研究表明，除非患者不适合手术，否则手术是人工瓣膜心内膜炎的首选治疗方法。应尽快进行手术，尤其是对血流动力学不稳定的患者以及出现心力衰竭、瓣膜功能障碍、反流/梗阻、裂开和瓣周脓肿等并发症的患者。除了上述人工瓣膜心内膜炎的指征和心脏/瓣膜相关并发症外，金黄色葡萄球菌感染对结局起着重要作用，这种微生物的存在应被视为人工瓣膜心内膜炎治疗中的紧急手术指征。手术应在任何脑部或其他并发症出现之前进行。相比之下，对于感染其他微生物且病情稳定的患者，尤其是那些对抗生素治疗敏感、无瓣膜结构损害或心脏并发症的患者，可以推迟手术。如果治疗反应发生变化也可以重新考虑手术干预选项。此选项仅适用于选定的患者，我们得出结论，一旦确诊人工瓣膜心内膜炎，心脏外科医生就应参与其中。
