Grubitzsch Herko, Schäfer Andreas, Claus Benamin, Treskatsch Sascha, Sander Michael, Wolfgang Konertz
J Heart Valve Dis. 2014 Nov;23(6):752-8.
Mechanical circulatory support (11 intra-aortic balloon pump; two right ventricular assist device; one left ventricular assist device) was required in 14 patients (9.4%). At 30 days, mortality was 12.8% (n=17) and morbidity 78.5% (117 patients experienced at least one complication). At one, five and 10 years, the overall survival was 78.4 +/- 3.5%, 76.7 +/- 3.6% and 74.9 +/- 3.8%, respectively. The duration of postoperative MV was 8 +/- 20.7 days, while ICU and hospital stays were 11 +/- 20.8 and 37 +/- 30.2 days, respectively. The following predictors for increased resource utilization were identified: preoperative ventilatory support, mechanical circulatory support, recent myocardial infarction, and urgency for MV >3 days; preoperative ventilator support and mechanical circulatory support for ICU >7 days; and urgency and age for HS >42 days.
A critical preoperative state and perioperative mechanical circulatory were strongly predictive of increased resource utilization. Hence, if resource utilization is to be reduced, an early operation seems more appropriate than to postpone surgery until an uncertain or unattainable re-normalization of organ dysfunction becomes evident.
Surgery for prosthetic valve endocarditis (PVE) is associated with significant morbidity and mortality. As treatment also demands substantial healthcare resources, a search was made for determinants of increased resource utilization.
Between 2000 and 2010, a total of 149 consecutive patients (107 males, 42 females; mean age 63.5 +/- 13.8 years) underwent re-do surgery for PVE at the authors' institution; 92 patients (61.7%) had aortic valve replacement, 42 (28.2%) had mitral valve replacement, and 15 (10.1%) had double valve replacement. Multivariate binary regression analysis was used to identify predictors of increased resource utilization, defined as mechanical ventilation (MV) >3 days, intensive care unit (ICU) stay >7 days, and hospital stay (HS) >42 days.
Preoperatively, 14 patients (9.4%) presented with shock and 17 (11.4%) with acute renal failure. Ventilatory and pharmacological circulatory support was required in 17 (11.4%) and 19 (12.8%) patients, respectively. The logistic EuroSCORE was >20% in 121 patients (81.2%). Staphylococci were the most common infecting microorganisms (41 patients; 27.5%), while 53 cases (35.6%) were culture-negative. The operative, cardiopulmonary bypass and aortic cross-clamp times were 259 + 88.3 min, 149 +/- 62.4 min, and 112 +/- 44.3 min, respectively.
14例患者（9.4%）需要机械循环支持（11例使用主动脉内球囊反搏；2例使用右心室辅助装置；1例使用左心室辅助装置）。30天时，死亡率为12.8%（n = 17），发病率为78.5%（117例患者至少发生一种并发症）。1年、5年和10年时，总体生存率分别为78.4±3.5%、76.7±3.6%和74.9±3.8%。术后机械通气时间为8±20.7天，而重症监护病房（ICU）住院时间和住院时间分别为11±20.8天和37±30.2天。确定了以下资源利用增加的预测因素：术前通气支持、机械循环支持、近期心肌梗死以及机械通气紧急情况>3天；术前呼吸机支持和机械循环支持导致ICU住院>7天；以及机械通气紧急情况和年龄导致住院时间>42天。
术前危急状态和围手术期机械循环强烈预示资源利用增加。因此，如果要减少资源利用，早期手术似乎比推迟手术直到器官功能障碍不确定或无法恢复正常更为合适。
人工瓣膜心内膜炎（PVE）手术伴有显著的发病率和死亡率。由于治疗还需要大量医疗资源，因此寻找资源利用增加的决定因素。
2000年至2010年期间，作者所在机构共有149例连续患者（107例男性，42例女性；平均年龄63.5±13.8岁）接受了PVE再次手术；92例患者（61.7%）进行了主动脉瓣置换，42例（28.2%）进行了二尖瓣置换，15例（10.1%）进行了双瓣置换。多变量二元回归分析用于确定资源利用增加的预测因素，定义为机械通气（MV）>3天、重症监护病房（ICU）住院>7天和住院时间（HS）>42天。
术前，14例患者（9.4%）出现休克，17例（11.4%）出现急性肾衰竭。分别有17例（11.4%）和19例（12.8%）患者需要通气和药物循环支持。121例患者（81.2%）的逻辑欧洲心脏手术风险评估系统（EuroSCORE）>20%。葡萄球菌是最常见的感染微生物（41例患者；27.5%），而53例（35.6%）培养结果为阴性。手术时间、体外循环时间和主动脉阻断时间分别为259 + 88.3分钟、149±62.4分钟和112±44.3分钟。
