Machado Maurício Nassau, Nakazone Marcelo Arruda, Murad-Júnior Jamil Ali, Maia Lilia Nigro
Cardiac Intensive Care Unit from Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, Brazil.
Rev Bras Cir Cardiovasc. 2013 Mar;28(1):29-35. doi: 10.5935/1678-9741.20130006.
We evaluated patients underwent cardiac valve surgery in the presence of infective endocarditis in an attempt to identify independent predictors of 30-day mortality.
We evaluated 837 consecutive patients underwent cardiac valve surgery from January 2003 to May 2010 in a tertiary hospital in São José do Rio Preto, São Paulo (SP), Brazil. The study group comprised patients who underwent intervention in the presence of infective endocarditis and was compared to the control group (without infective endocarditis), evaluating perioperative clinical outcomes and 30-day all cause mortality.
In our series, 64 patients (8%) underwent cardiac valve surgery in the presence of infective endocarditis, and 37.5% of them had surgical intervention in multiple valves. The study group had prolonged ICU length of stay (16%), greater need for dialysis (9%) and higher 30-day mortality (17%) compared to the control group (7%, P=0.020; 2%, P=0.002 and 9%, P=0.038; respectively). In a Cox regression analysis, age (P = 0.007), acute kidney injury (P = 0.004), dialysis (P = 0.026), redo surgery (P = 0.026), re-exploration for bleeding (P = 0.013), tracheal reintubation (P <0.001) and type I neurological injury (P <0.001) were identified as independent predictors for death. Although the manifestation of infective endocarditis influenced on mortality in univariate analysis, multivariate Cox regression analysis did not confirm such variable as an independent predictor of death.
Age and perioperative complications stand out as predictors of hospital mortality in Brazilian population. Cardiac valve surgery in the presence of active infective endocarditis was not confirmed itself as an independent predictor of 30-day mortality.
我们对患有感染性心内膜炎时接受心脏瓣膜手术的患者进行了评估，试图确定30天死亡率的独立预测因素。
我们评估了2003年1月至2010年5月在巴西圣保罗州里奥普雷图河畔圣若泽的一家三级医院连续接受心脏瓣膜手术的837例患者。研究组包括在患有感染性心内膜炎时接受干预的患者，并与对照组（无感染性心内膜炎）进行比较，评估围手术期临床结局和30天全因死亡率。
在我们的系列研究中，64例（8%）患者在患有感染性心内膜炎时接受了心脏瓣膜手术，其中37.5%的患者对多个瓣膜进行了手术干预。与对照组相比，研究组的重症监护病房住院时间延长（16%）、透析需求更大（9%）且30天死亡率更高（17%）（分别为7%，P = 0.020；2%，P = 0.002；9%，P = 0.038）。在Cox回归分析中，年龄（P = 0.007）、急性肾损伤（P = 0.004）、透析（P = 0.026）、再次手术（P = 0.026）、因出血再次探查（P = 0.013）、气管再次插管（P <0.001）和I型神经损伤（P <0.001）被确定为死亡的独立预测因素。尽管感染性心内膜炎的表现在单因素分析中影响死亡率，但多因素Cox回归分析未证实该变量是死亡的独立预测因素。
年龄和围手术期并发症是巴西人群医院死亡率的预测因素。患有活动性感染性心内膜炎时进行心脏瓣膜手术本身未被证实是30天死亡率的独立预测因素。
