From Duke University Medical Center, Durham, NC (V.H.C., L.P.P., A.W.); Barwon Health and Deakin University, Geelong, Australia (E.A.); Hospital Louis Pradel, Lyon-Bron, France (F.D.); Center for Cardiovascular Surgery and Transplantation, Brno, and Central European Institute of Technology, Masaryk University, Brno, Czech Republic (T.F.); Instituto Nacional de Cardiologia, and Unigranrio, Rio de Janeiro, Brazil (C.L.); Infectious Diseases Service, Hospital Clinic-August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain (J.M.M., J.M.P.); OhioHealth Heart and Vascular Physicians, Columbus, OH (D.W.M.); Hadassah-Hebrew University Medical Center, Jerusalem, Israel (J.S.); University Hospital, Amiens, and INSERM U-1088, University of Picardie, Amiens, France (C.T.); Internal Medicine, University of Naples SUN, Monaldi Hospital, Naples, Italy (E.D.-M.); Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain (N.F.-H.); Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (F.N.); Cairo University Hospital, Cairo, Egypt (H.R.); University Hospital for Infectious Diseases, Zagreb, Croatia (V.K.); Attikon University General Hospital, Athens, Greece (E.G.); and Mater Misericordiae University Hospital, Dublin, Ireland (J.P.H., M.M.H.).
Circulation. 2015 Jan 13;131(2):131-40. doi: 10.1161/CIRCULATIONAHA.114.012461. Epub 2014 Dec 5.
Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined.
The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device-related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE.
Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period. S aureus IE was significantly associated with nonsurgical management.
手术治疗感染性心内膜炎（IE）与手术适应证和手术死亡率相关的手术风险尚未明确界定。
国际心内膜炎协作研究-PLUS（ICE-PLUS）是一项前瞻性队列研究，纳入了来自 16 个国家 29 个中心的明确 IE 患者。我们纳入了来自 ICE-PLUS 的明确左侧非心脏器械相关 IE 患者，这些患者于 2008 年 9 月 1 日至 2012 年 12 月 31 日期间入组。共有 1296 例左侧 IE 患者被纳入研究。总体队列中有 57%的患者接受了手术治疗，有手术适应证的患者中有 76%接受了手术治疗。非手术治疗的原因包括预后不良（33.7%）、血流动力学不稳定（19.8%）、手术前死亡（23.3%）、卒中（22.7%）和脓毒症（21%）。在有手术适应证的患者中，手术治疗与严重主动脉瓣反流、脓肿、手术前栓塞以及从外院转来等因素独立相关。与非手术治疗相关的变量包括中度/重度肝脏疾病史、手术前卒中史和金黄色葡萄球菌病因。手术适应证、胸外科医师协会 IE 评分和手术的综合应用与 IE 患者 6 个月的生存率相关。
IE 手术决策在很大程度上与既定指南一致，尽管近四分之一有手术适应证的患者未接受手术。胸外科医师协会 IE 评分的手术风险评估可提供手术期后生存率的预后信息。金黄色葡萄球菌 IE 与非手术治疗显著相关。
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