Department of Cardiovascular Sciences, Institute of Cardiac surgery, Catholic University of Sacred Heart, A. Gemelli Hospital, Roma, Italy.
Department of Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy.
Eur J Cardiothorac Surg. 2017 Oct 1;52(4):768-774. doi: 10.1093/ejcts/ezx169.
Prosthetic valve endocarditis (PVE) is an uncommon yet dreadful complication in patients with prosthetic valves that requires a distinct analysis from native valve endocarditis. The present study aims to investigate independent risk factors for early surgical outcomes in patients with PVE.
A retrospective cohort study was conducted in 8 Italian Cardiac Surgery Units from January 2000 to December 2013 by enrolling all PVE patients undergoing surgical treatment.
A total of 209 consecutive patients were included in the study. During the study period, the global rate of surgical procedures for PVE among all operations for isolated or associated valvular disease was 0.45%. Despite its rarity this percentage increased significantly during the second time frame (2007-2013) in comparison with the previous one (2000-2006): 0.58% vs 0.31% (P < 0.001). Intraoperative and in-hospital mortality rates were 4.3% and 21.5%, respectively. Logistic regression analysis identified the following factors associated with in-hospital mortality: female gender [odds ratio (OR) = 4.62; P < 0.001], shock status (OR = 3.29; P = 0.02), previous surgical procedures within 3 months from the treatment (OR = 3.57; P = 0.009), multivalvular involvement (OR = 8.04; P = 0.003), abscess (OR = 2.48; P = 0.03) and urgent surgery (OR = 6.63; P < 0.001).
Despite its rarity, PVE showed a significant increase over time. Up to now, in-hospital mortality after surgical treatment still remains high (>20%). Critical clinical presentation and extension of anatomical lesions are strong preoperative predictors for poor early outcome.
人工瓣膜心内膜炎（PVE）是人工瓣膜患者中一种罕见但严重的并发症，需要与原发性心内膜炎进行明确的分析。本研究旨在探讨 PVE 患者早期手术结果的独立危险因素。
本研究为 2000 年 1 月至 2013 年 12 月期间在意大利 8 个心脏外科中心进行的回顾性队列研究，纳入所有接受手术治疗的 PVE 患者。
共纳入 209 例连续患者。在研究期间，所有孤立或联合瓣膜疾病手术中，PVE 手术的全球比例为 0.45%。尽管其发病率较低，但在第二个时间段（2007-2013 年）与前一个时间段（2000-2006 年）相比，该比例显著增加：0.58%比 0.31%（P<0.001）。术中及住院死亡率分别为 4.3%和 21.5%。Logistic 回归分析确定了与住院死亡率相关的因素包括：女性（比值比[OR] = 4.62；P<0.001）、休克状态（OR = 3.29；P = 0.02）、治疗前 3 个月内的手术史（OR = 3.57；P = 0.009）、多瓣膜受累（OR = 8.04；P = 0.003）、脓肿（OR = 2.48；P = 0.03）和急诊手术（OR = 6.63；P<0.001）。
尽管发病率较低，但 PVE 随时间呈显著增加趋势。到目前为止，手术后住院死亡率仍居高不下（>20%）。严重的临床症状和解剖病变的扩展是手术早期预后不良的强预测因素。
