Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
J Thorac Cardiovasc Surg. 2014 Jan;147(1):349-54. doi: 10.1016/j.jtcvs.2012.12.007. Epub 2013 Jan 12.
We reviewed our experience with the operative management of patients with isolated nonnative mitral valve infective endocarditis to better understand the outcome.
We reviewed the records of 39 patients operated on for isolated nonnative mitral valve infective endocarditis from January 1974 to June 2009. Median age of the group was 68 years. There were 23 (59%) women. Prostheses were mechanical in 18 (46%) patients, biological in 18 (46%), and annuloplasty rings in 3 (8%). Staphylococcus was present in 22 (56%) patients. Operative indications included valve dysfunction in 26 (67%) patients and heart failure in 22 (56%).
Perivalvular abscess was present in 12 (31%) patients. Replacement valves were mechanical in 23 (59%) patients and biological in 16 (41%). Twenty (51%) patients received additional operative procedures. Treatment-related mortality occurred in 8 (21%) patients, with age being the only factor predictive of mortality (hazard ratio, 5.37). Follow-up of the survivors was 5.7 years. Six (18%) patients underwent repeat mitral valve replacement including 3 who had an annulus abscess at the initial operation and 2 who had the prosthesis sutured to the left atrial wall. There was 1 (4%) case of recurrent endocarditis in the group of 28 patients who survived more than 1 year after the incident operation. Survival at 5 years was 48% (95% confidence interval, 35%-67%).
Surgery for isolated nonnative mitral valve infective endocarditis carries increased operative risk. Aggressive debridement and reconstruction of the annulus are paramount to achieving a good outcome. Surviving patients obtain high rates of cure and freedom from recurrent infective endocarditis.
我们回顾了孤立性非native 二尖瓣感染性心内膜炎患者的手术治疗经验，以更好地了解其结局。
我们回顾了 1974 年 1 月至 2009 年 6 月期间因孤立性非native 二尖瓣感染性心内膜炎接受手术治疗的 39 例患者的病历。该组患者的中位年龄为 68 岁，其中 23 例（59%）为女性。18 例（46%）患者的瓣膜为机械瓣，18 例（46%）为生物瓣，3 例（8%）为瓣环成形环。22 例（56%）患者的病原体为葡萄球菌。手术适应证包括瓣膜功能障碍 26 例（67%）和心力衰竭 22 例（56%）。
12 例（31%）患者存在瓣周脓肿。23 例（59%）患者置换的是机械瓣，16 例（41%）患者置换的是生物瓣。20 例（51%）患者接受了其他手术。8 例（21%）患者发生治疗相关死亡，年龄是唯一预测死亡率的因素（危险比为 5.37）。幸存者的随访时间为 5.7 年。6 例（18%）患者再次接受二尖瓣置换术，其中 3 例在初次手术时存在瓣环脓肿，2 例假体与左心房壁缝合。在 28 例存活超过 1 年的患者中，有 1 例（4%）发生复发性心内膜炎。5 年生存率为 48%（95%置信区间，35%-67%）。
孤立性非native 二尖瓣感染性心内膜炎的手术治疗风险增加。积极清创和瓣环重建对于获得良好的结局至关重要。存活的患者获得了较高的治愈率和免于复发性感染性心内膜炎的机会。
