伴有脑部并发症的活动性感染性心内膜炎的最佳手术时机：一项日本多中心研究
Optimal timing of surgery for active infective endocarditis with cerebral complications: a Japanese multicentre study.
作者信息
Okita Yutaka, Minakata Kenji, Yasuno Shinji, Uozumi Ryuji, Sato Tosiya, Ueshima Kenji, Konishi Hiroaki, Morita Naomi, Harada Masafumi, Kobayashi Junjiro, Suehiro Shigefumi, Kawahito Koji, Okabayashi Hitoshi, Takanashi Shuichiro, Ueda Yuichi, Usui Akihiko, Imoto Kiyotaka, Tanaka Hiroyuki, Okamura Yoshitaka, Sakata Ryuzo, Yaku Hitoshi, Tanemoto Kazuo, Imoto Yutaka, Hashimoto Kazuhiro, Bando Ko
机构信息
Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
Kyoto University Graduate School of Medicine, Kyoto, Japan.
出版信息
Eur J Cardiothorac Surg. 2016 Aug;50(2):374-82. doi: 10.1093/ejcts/ezw035. Epub 2016 Mar 10.
OBJECTIVES
The aim of this study was to investigate the effect of the timing of valve surgery on the clinical outcomes of patients with active infective endocarditis (IE) accompanied by cerebral complications.
METHODS
We retrospectively analysed a cohort of 568 patients, comprising 118 with non-haemorrhagic cerebral infarction (CI), 54 with intracranial haemorrhage (ICH) and 396 without cerebral events (C; control), who underwent surgery for left-sided active IE in 15 Japanese institutes from 2000 to 2011. The mean age was 58.4 ± 16.9 years in the CI group; 54.5 ± 17.4 years in the ICH group and 56.9 ± 16.0 years in the C group. Clinical outcomes were analysed according to the timing of surgery after the diagnosis of CI or ICH was made.
RESULTS
In the CI group, there were 9 (7.6%) hospital deaths, 13 (11%) new cerebral events and 1 (0.8%) redo valve surgery. In the ICH group, there were 3 (5.6%) hospital deaths, 8 (14.8%) new cerebral events and 2 (3.7%) redo valve surgeries. In the C group, there were 36 (9.1%) hospital deaths, 23 (5.8%) new cerebral events and 9 (2.3%) redo valve surgeries. Risk factors for hospital death were prosthetic valve endocarditis (P = 0.045), high C-reactive protein (CRP; P < 0.001) and the elderly (P < 0.001) in the CI group. Delayed surgery (2 weeks after CI) seemed result in a higher incidence of hospital death in the CI group. Patients who had surgery between 15 and 28 days or after 29 days from the onset of CI had higher incidences of hospital death [odds ratio 5.90 (P = 0.107) and 4.92 (P = 0.137), respectively] compared with those who had surgery within 7 days. In the ICH group, risk factors for hospital death were high CRP (P = 0.002) and elderly (P < 0.001). Contrary to CI patients, patients who had surgery between 8 and 21 days or after 22 days after the onset of ICH had lower incidences of hospital death [odds ratio 0.79 (P = 0.843) and 0.12 (P = 0.200), respectively] compared with those who had surgery within 7 days.
CONCLUSIONS
Although statistically insignificant, early surgery in active IE patients with CI is safe, but very early surgery (within 7 days) should be avoided in patients with ICH.
目的
本研究旨在探讨瓣膜手术时机对伴有脑部并发症的活动性感染性心内膜炎（IE）患者临床结局的影响。
方法
我们回顾性分析了2000年至2011年期间在15家日本机构接受左侧活动性IE手术的568例患者，其中包括118例非出血性脑梗死（CI）患者、54例颅内出血（ICH）患者和396例无脑部事件（C组；对照组）患者。CI组的平均年龄为58.4±16.9岁；ICH组为54.5±17.4岁，C组为56.9±16.0岁。根据CI或ICH诊断后的手术时机分析临床结局。
结果
CI组有9例（7.6%）住院死亡、13例（11%）新发脑部事件和1例（0.8%）再次瓣膜手术。ICH组有3例（5.6%）住院死亡、8例（14.8%）新发脑部事件和2例（3.7%）再次瓣膜手术。C组有36例（9.1%）住院死亡、23例（5.8%）新发脑部事件和9例（2.3%）再次瓣膜手术。CI组住院死亡的危险因素为人工瓣膜心内膜炎（P = 0.045）、高C反应蛋白（CRP；P < 0.001）和老年患者（P < 0.001）。延迟手术（CI后2周）似乎导致CI组住院死亡发生率更高。与在7天内进行手术的患者相比，在CI发病后15至28天或29天后进行手术的患者住院死亡发生率更高[比值比分别为5.90（P = 0.107）和4.92（P = 0.137）]。在ICH组，住院死亡的危险因素为高CRP（P = 0.002）和老年患者（P < 0.001）。与CI患者相反，与在7天内进行手术的患者相比，在ICH发病后8至21天或22天后进行手术的患者住院死亡发生率更低[比值比分别为0.79（P = 0.843）和0.12（P = 0.200）]。
结论
虽然无统计学意义，但CI的活动性IE患者早期手术是安全的，但ICH患者应避免极早期手术（7天内）。
Zotero 插件