Johannesdottir Ragnheiður M, Gudbjartsson Tomas, Geirsson Arnar
Laeknabladid. 2017;102(2):79-85. doi: 10.17992/lbl.2017.02.122.
The aim of this study was to evaluate the outcomes of operations for endocarditis in Iceland, but such results have not been reported before.
Retrospective nation-wide study of pa--tients that underwent open-heart surgery for infective endocarditis at Landspitali University Hospital in 1997-2013. Variables were collected from hospital charts. Long-term survival was analysed using Kaplan- Meier methods. Mean follow-up time was 7.2 years.
Out of 179 patients diagnosed with endocarditis, 38 (21%) -underwent open heart surgery. Two patients were excluded due to missing information leaving 36 patients for analysis. The number of operations steadily increased, or from 8 to 21 during the first and last 5-years of the study period (OR: 1.12, 95% CI: 1.05-1.21, p=0.002). The most common pathogen was S. aureus and 81% (29/36) of the patients had positive blood cultures. Three patients had history of previous cardiac surgery and five had history of intravenous drug abuse. The aortic valve was most often infected (72%), followed by the mitral valve (28%). The infected valve was replaced in 35 cases 14 with a mechanical prosthesis and 20 with a bioprosthesis. In addition two mitral valves were repaired. Postoperative complications included perioperative myocardial infarction (35%), respiratory failure (44%) and reoperation for bleeding (25%). Thirty-day mortality was 11% (4 patients) with 5- and 10-year survival of 59% and 49%, respectively.
One out of five patients with endocarditis underwent surgery, most commonly aortic or mitral valve replacement. Outcomes were comparable to other studies. In comparison to elective valve replace-ment surgery the rate of post-operative complications and 30-day mortality were higher and long-term survival was less favorable. Key words: Endocarditis, surgical treatment, valve replacement, complications, outcome. Correspondence: Arnar Geirsson, arnargeirsson@yahoo.com.
本研究旨在评估冰岛心内膜炎手术的结果，但此前尚未有此类结果的报道。
对1997年至2013年在冰岛国家大学医院因感染性心内膜炎接受心脏直视手术的患者进行全国性回顾性研究。从医院病历中收集变量。使用Kaplan-Meier方法分析长期生存率。平均随访时间为7.2年。
在179例被诊断为心内膜炎的患者中，38例（21%）接受了心脏直视手术。2例因信息缺失被排除，剩余36例用于分析。手术数量稳步增加，在研究期的前5年和最后5年分别从8例增加到21例（比值比：1.12，95%可信区间：1.05-1.21，p=0.002）。最常见的病原体是金黄色葡萄球菌，81%（29/36）的患者血培养呈阳性。3例患者有心脏手术史，5例有静脉药物滥用史。主动脉瓣最常受感染（72%），其次是二尖瓣（28%）。35例患者的感染瓣膜被置换，14例使用机械瓣膜，20例使用生物瓣膜。此外，2例二尖瓣进行了修复。术后并发症包括围手术期心肌梗死（35%）、呼吸衰竭（44%）和因出血再次手术（25%）。30天死亡率为11%（4例患者），5年和10年生存率分别为59%和49%。
五分之一的心内膜炎患者接受了手术，最常见的是主动脉瓣或二尖瓣置换。结果与其他研究相当。与择期瓣膜置换手术相比，术后并发症发生率和30天死亡率更高，长期生存率更不理想。关键词：心内膜炎、手术治疗、瓣膜置换、并发症、结果。通信作者：Arnar Geirsson，arnargeirsson@yahoo.com 。
