感染性心内膜炎手术治疗的结果：单中心 801 例患者的经验。

Outcomes of surgery for infective endocarditis: a single-centre experience of 801 patients.

机构信息

Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.

出版信息

Eur J Cardiothorac Surg. 2018 Feb 1;53(2):435-439. doi: 10.1093/ejcts/ezx341.

DOI:10.1093/ejcts/ezx341

PMID:29029030

Abstract

OBJECTIVES

Infective endocarditis (IE) remains a life-threatening disease, despite the improvement in diagnostic and therapeutic measures. We reviewed our outcomes for all adults who underwent surgery for endocarditis at our centre.

METHODS

Between January 1995 and December 2013, 801 patients [586 men (73%)] underwent surgery for IE. Mean age was 60 ± 14.7 years. Native endocarditis (NE) was present in 372 patients (46%), and 379 (47%) patients had active IE. The mean follow-up period was 4.6 ± 4.75 years (maximum 20 years).

RESULTS

Single-valve endocarditis was present in 551 (69%) patients (392 aortic and 159 mitral). Multivalve involvement was present in 250 (31%) patients. Preoperative stroke was present in 149 (19%) patients, while 62 (8%) patients were on dialysis prior to surgery. Valve repair was possible in 122 (15%) patients, while 679 (85%) patients underwent valve replacement. Mechanical valves were used in 312 (39%) patients. Aortic homografts were used in 84 (10%) patients. Early mortality occurred in 64 (8%) patients. Overall survival at 5, 10 and 20 years was 68%, 45% and 8.4%, respectively. Postoperative stroke occurred in 16 (2%) patients, while 59 (7%) patients required new dialysis postoperatively. Multivariate analysis revealed active IE (P = 0.002), preoperative dialysis (P = 0.007), previous coronary artery bypass grafting (P = 0.001), root abscess (P = 0.006) and tricuspid valve or multivalve involvement (P = 0.002) to be predictors of early mortality. The need for dialysis (P < 0.001), previous coronary artery bypass grafting (P < 0.001) and mitral valve (P = 0.002) and tricuspid valve/multivalve involvement (P < 0.001) were significant predictors of late mortality.

CONCLUSIONS

Active IE is associated with high perioperative mortality especially with multivalve and aortic root involvement. Preoperative stroke has no impact on perioperative mortality. Long-term survival for those who survived the immediate postoperative period is satisfactory, and mechanical valves are associated with the best long-term survival.

摘要

目的

尽管在诊断和治疗措施方面有所改善，但感染性心内膜炎（IE）仍然是一种危及生命的疾病。我们回顾了在我们中心接受心内膜炎手术的所有成年患者的结局。

方法

1995 年 1 月至 2013 年 12 月，801 例患者[586 例男性（73%）]因 IE 接受了手术。平均年龄为 60±14.7 岁。372 例（46%）患者存在原发性心内膜炎（NE），379 例（47%）患者患有活动性 IE。平均随访时间为 4.6±4.75 年（最长 20 年）。

结果

551 例（69%）患者存在单瓣膜心内膜炎（392 例主动脉瓣和 159 例二尖瓣）。250 例（31%）患者存在多瓣膜受累。术前存在脑卒中的患者为 149 例（19%），62 例（8%）患者在手术前接受透析。122 例（15%）患者可行瓣膜修复，679 例（85%）患者行瓣膜置换术。312 例（39%）患者使用机械瓣膜。84 例（10%）患者使用同种主动脉瓣。64 例（8%）患者早期死亡。5、10 和 20 年的总体生存率分别为 68%、45%和 8.4%。术后发生脑卒中的患者为 16 例（2%），59 例（7%）患者术后需要新的透析。多变量分析显示活动性 IE（P=0.002）、术前透析（P=0.007）、既往冠状动脉旁路移植术（P=0.001）、根部脓肿（P=0.006）和三尖瓣或多瓣膜受累（P=0.002）是早期死亡率的预测因素。需要透析（P<0.001）、既往冠状动脉旁路移植术（P<0.001）、二尖瓣（P=0.002）和三尖瓣/多瓣膜受累（P<0.001）是晚期死亡率的显著预测因素。