Tepsuwan Thitipong, Rimsukcharoenchai Chartaroon, Tantraworasin Apichat, Woragidpoonpol Surin, Schuarattanapong Suphachai, Nawarawong Weerachai
Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Cardiothoracic Division, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Asian Cardiovasc Thorac Ann. 2016 May;24(4):309-15. doi: 10.1177/0218492316637714. Epub 2016 Feb 27.
Timing of surgery in the management of infective endocarditis is controversial, and there is still no definite conclusion on how early the surgery should be performed. This study focuses on the outcomes of surgery during the active period of infective endocarditis in consideration of the duration after diagnosis.
One hundred and thirty-four patients with active native valve infective endocarditis who underwent surgery from January 2006 to December 2013 were reviewed retrospectively. They were divided in 2 groups based on timing of surgery: early group (first week after diagnosis, n = 37) and delayed group (2 to 6 weeks after diagnosis, n = 97).
Compared to the delayed group, the early group had significantly more patients in New York Heart Association class IV (81% vs. 43.3%), more mechanically ventilated (54.1% vs. 18.6%), more on inotropic support (62.2% vs. 38.1%), and hence a worse EuroSCORE II (14.8% vs. 8.8%). Operative mortality was comparable (5.4% vs. 10.3%) and 7-year survival was similar (77.4% vs. 74.6%). On multivariable regression analysis, delayed surgery did not impact on short- and long-term outcomes. Preoperative cardiac arrest and infection with Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, or Kingella were risk factors for higher operative mortality. Predictors of poor 7-year survival were diabetes mellitus and acute renal failure.
Delayed surgery is not associated with worse outcomes. Both early and delayed approaches are safe and provide acceptable results. Timing of surgery should be tailored to each patient's clinical status, not based on duration of endocarditis alone.
感染性心内膜炎治疗中手术时机存在争议，对于手术应多早进行尚无定论。本研究考虑诊断后的病程，重点关注感染性心内膜炎活动期手术的结果。
回顾性分析2006年1月至2013年12月期间接受手术的134例活动性自体瓣膜感染性心内膜炎患者。根据手术时机将他们分为两组：早期组（诊断后第一周，n = 37）和延迟组（诊断后2至6周，n = 97）。
与延迟组相比，早期组纽约心脏协会IV级患者明显更多（81%对43.3%），机械通气患者更多（54.1%对18.6%），使用血管活性药物支持的患者更多（62.2%对38.1%），因此欧洲心脏手术风险评估系统II评分更差（14.8%对8.8%）。手术死亡率相当（5.4%对10.3%），7年生存率相似（77.4%对74.6%）。多变量回归分析显示，延迟手术对短期和长期结果无影响。术前心脏骤停以及感染嗜血杆菌、放线杆菌、心杆菌、艾肯菌或金氏杆菌是手术死亡率较高的危险因素。7年生存率低的预测因素是糖尿病和急性肾衰竭。
延迟手术与更差的结果无关。早期和延迟手术方法都是安全的，且能提供可接受的结果。手术时机应根据每个患者的临床状况进行调整，而不仅仅基于心内膜炎的病程。
