人造瓣膜心内膜炎的手术治疗：国家注册处的回顾性研究。

Surgery for prosthetic valve endocarditis: a retrospective study of a national registry.

机构信息

Italian Group for Research on Surgical Outcomes (GIROC), Italian Society of Cardiac Surgery (SICCH), Rome, Italy.

出版信息

Eur J Cardiothorac Surg. 2017 Jul 1;52(1):105-111. doi: 10.1093/ejcts/ezx045.

DOI:10.1093/ejcts/ezx045

PMID:28329161

Abstract

OBJECTIVES

We described clinical-epidemiological features of prosthetic valve endocarditis (PVE) and assessed the determinants of early surgical outcomes in multicentre design.

METHODS

Data regarding 2823 patients undergoing surgery for endocarditis at 19 Italian Centers between 1979 and 2015 were collected in a database. Of them, 582 had PVE: in this group, the determinants of early mortality and complications were assessed, also taking into account the different chronological eras encompassed by the study.

RESULTS

Overall hospital (30-day) mortality was 19.2% (112 patients). Postoperative complications of any type occurred in 256 patients (44%). Across 3 eras (1980-2000, 2001-08 and 2009-14), early mortality did not significantly change (20.4%, 17.1%, 20.5%, respectively, P = 0.60), whereas complication rate increased (18.5%, 38.2%, 52.8%, P < 0.001), consistent with increasing mean patient age (56 ± 14, 64 ± 15, 65 ± 14 years, respectively, P < 0.001) and median logistic EuroSCORE (14%, 21%, 23%, P = 0.025). Older age, female sex, preoperative serum creatinine >-2 mg/dl, chronic pulmonary disease, low ejection fraction, non-streptococcal aetiology, active endocarditis, preoperative intubation, preoperative shock and triple valve surgery were significantly associated with mortality. In multivariable analysis, age (OR = 1.02; P = 0.03), renal insufficiency (OR = 2.1; P = 0.05), triple valve surgery (OR = 6.9; P = 0.004) and shock (OR = 4.5; P < 0.001) were independently associated with mortality, while streptococcal aetiology, healed endocarditis and ejection fraction with survival. Adjusting for study era, preoperative shock (OR = 3; P < 0.001), Enterococcus (OR = 2.3; P = 0.01) and female sex (OR = 1.5; P = 0.03) independently predicted complications, whereas ejection fraction was protective.

CONCLUSIONS

PVE surgery remains a high-risk one. The strongest predictors of early outcome of PVE surgery are related to patient's haemodynamic status and microbiological factors.

摘要

目的

我们描述了人工心脏瓣膜心内膜炎（PVE）的临床流行病学特征，并评估了多中心设计中早期手术结果的决定因素。

方法

在数据库中收集了 1979 年至 2015 年间意大利 19 个中心因心内膜炎接受手术的 2823 名患者的数据。其中，582 名患者患有 PVE：在该组中，评估了早期死亡率和并发症的决定因素，同时还考虑了研究中包含的不同时间阶段。

结果

总体医院（30 天）死亡率为 19.2%（112 例）。256 名患者（44%）发生任何类型的术后并发症。在 3 个时期（1980-2000 年、2001-2008 年和 2009-2014 年），早期死亡率没有显著变化（分别为 20.4%、17.1%和 20.5%，P = 0.60），而并发症发生率增加（分别为 18.5%、38.2%和 52.8%，P < 0.001），与患者年龄的平均增长（56 ± 14、64 ± 15 和 65 ± 14 岁，P < 0.001）和中位逻辑 EuroSCORE（14%、21%和 23%，P = 0.025）一致。年龄较大、女性、术前血清肌酐>2mg/dl、慢性肺部疾病、射血分数较低、非链球菌病因、活动性心内膜炎、术前插管、术前休克和三尖瓣手术与死亡率显著相关。多变量分析显示，年龄（OR = 1.02；P = 0.03）、肾功能不全（OR = 2.1；P = 0.05）、三尖瓣手术（OR = 6.9；P = 0.004）和休克（OR = 4.5；P < 0.001）与死亡率独立相关，而链球菌病因、愈合性心内膜炎和射血分数与生存率相关。调整研究时期后，术前休克（OR = 3；P < 0.001）、肠球菌（OR = 2.3；P = 0.01）和女性（OR = 1.5；P = 0.03）独立预测并发症，而射血分数具有保护作用。