Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden.
Ann Thorac Surg. 2013 May;95(5):1551-6. doi: 10.1016/j.athoracsur.2013.03.006. Epub 2013 Apr 3.
The objective was to compare long-term survival after operations for active infective endocarditis (IE) in native or prosthetic valves. We also investigated differences in early death and postoperative complications.
We conducted a population-based cohort study including all patients who underwent operations for IE between January 2002 and July 2012. The SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry and patients records were used to acquire information about patient characteristics, preoperative comorbidities, and postoperative complications. Date of death was ascertained by using the Swedish personal identity number and the Total Population Register at Statistics Sweden. We used multivariable Cox regression to analyze the association between prosthetic valve IE and survival.
Of the 252 included patients, 22% underwent operations for prosthetic valve IE. There was no significant difference in unadjusted 5-year survival between patients who underwent operations for prosthetic valve IE compared with native valve IE (75% vs 65%; p = 0.34). We found no significant association between operations for prosthetic valve IE and death (multivariable adjusted hazard ratio, 0.83; 95% confidence interval, 0.46 to 1.49) compared with native valve IE. There was no significant difference in 30-day mortality between prosthetic and native valve IE (14% vs 12%; p = 0.61), with a multivariable adjusted odds ratio of 0.62 (95% confidence interval, 0.24 to 1.64).
We found no significant difference in long-term survival between patients who underwent operations for prosthetic valve IE compared with native valve IE. Early death and morbidity were also similar between the groups. These results are promising because an increasing amount of patients with IE have prosthetic valve infections.
本研究旨在比较原发性或人工瓣膜感染性心内膜炎（IE）患者手术后的长期生存情况。我们还研究了早期死亡率和术后并发症的差异。
我们进行了一项基于人群的队列研究，纳入了 2002 年 1 月至 2012 年 7 月期间接受 IE 手术的所有患者。SWEDEHEART（瑞典基于互联网的增强和发展证据为基础的心脏疾病治疗评估系统）登记处和患者病历用于获取患者特征、术前合并症和术后并发症的信息。通过使用瑞典个人身份证号码和瑞典统计局的总人口登记处来确定死亡日期。我们使用多变量 Cox 回归分析人工瓣膜 IE 与生存率之间的关系。
在 252 名纳入的患者中，22%的患者因人工瓣膜 IE 接受手术。与原发性瓣膜 IE 相比，人工瓣膜 IE 患者的未调整 5 年生存率无显著差异（75% vs 65%；p=0.34）。与原发性瓣膜 IE 相比，人工瓣膜 IE 与死亡之间无显著关联（多变量调整后的危险比为 0.83；95%置信区间，0.46 至 1.49）。人工瓣膜和原发性瓣膜 IE 之间 30 天死亡率无显著差异（14% vs 12%；p=0.61），多变量调整后的比值比为 0.62（95%置信区间，0.24 至 1.64）。
我们发现，与原发性瓣膜 IE 相比，人工瓣膜 IE 患者手术后的长期生存率无显著差异。两组的早期死亡率和发病率也相似。这些结果令人鼓舞，因为越来越多的 IE 患者存在人工瓣膜感染。
