Perrotta Sossio, Jeppsson Anders, Fröjd Victoria, Svensson Gunnar
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Thorac Cardiovasc Surg. 2017 Apr;65(3):166-173. doi: 10.1055/s-0036-1580622. Epub 2016 Apr 13.
A considerable proportion of patients with acute infective endocarditis require surgical treatment. The aim of this study was to collate our short- and medium-term results of surgical treatment of infective endocarditis and to compare the results in native and prosthetic endocarditis. Total 254 operations for infective endocarditis from January 2008 to May 2015 were included in this retrospective study. There were 182 operations for native valve endocarditis and 72 for prosthetic valve endocarditis. Patient characteristics, operative details, complications, and mortality were registered. The endocarditis was left sided in 247 operations (146 aortic, 78 mitral, and 23 double-valve) and right-sided in 7 (5 tricuspid and 2 pulmonary). Twenty-two patients (8.7%) died within 30 days (7.7% with native valve endocarditis and 11.1% with prosthetic valve endocarditis, = 0.31). Severe perioperative complications occurred in 99 of 254 operations (39%). Overall cumulative survival at 1 and 5 years was 86% and 75%, respectively, and it was not significantly different for native and prosthetic endocarditis ( = 0.31). Eighteen patients (8%) had one ( = 16) or two ( = 2) recurrent episodes of endocarditis requiring surgery. Surgery for infective endocarditis is still associated with a high early mortality rate and a considerable complication rate. Long-term outcome is acceptable. In our study population, morbidity and mortality were not significantly different in native and prosthetic endocarditis.
相当一部分急性感染性心内膜炎患者需要手术治疗。本研究的目的是整理我们对感染性心内膜炎手术治疗的短期和中期结果，并比较自体瓣膜心内膜炎和人工瓣膜心内膜炎的治疗结果。本回顾性研究纳入了2008年1月至2015年5月期间共254例感染性心内膜炎手术。其中自体瓣膜心内膜炎手术182例，人工瓣膜心内膜炎手术72例。记录了患者特征、手术细节、并发症和死亡率。247例手术的心内膜炎位于左侧（主动脉瓣146例、二尖瓣78例、双瓣膜23例），7例位于右侧（三尖瓣5例、肺动脉瓣2例）。22例患者（8.7%）在30天内死亡（自体瓣膜心内膜炎患者为7.7%，人工瓣膜心内膜炎患者为11.1%，P = 0.31）。254例手术中有99例（39%）发生严重围手术期并发症。1年和5年的总体累积生存率分别为86%和75%，自体瓣膜心内膜炎和人工瓣膜心内膜炎之间无显著差异（P = 0.31）。18例患者（8%）发生1次（n = 16）或2次（n = 2）感染性心内膜炎复发，需要再次手术。感染性心内膜炎手术仍与较高的早期死亡率和相当高的并发症发生率相关。长期预后尚可。在我们的研究人群中，自体瓣膜心内膜炎和人工瓣膜心内膜炎的发病率和死亡率无显著差异。
