感染性二尖瓣心内膜炎早期手术与延迟手术的结果

Outcome of early vs delayed surgery for infective mitral endocarditis.

作者信息

Huuskonen Antti, Vento Antti, Raivio Peter

机构信息

Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.

出版信息

J Card Surg. 2019 Aug;34(8):700-707. doi: 10.1111/jocs.14137. Epub 2019 Jul 3.

DOI:10.1111/jocs.14137

PMID:31269271

Abstract

BACKGROUND AND AIM OF THE STUDY

Timing of surgery for infective endocarditis is controversial. The objective of this study was to report the outcomes of early vs delayed surgery (DS) of mitral endocarditis.

METHODS

We retrospectively reviewed all patients treated surgically for mitral endocarditis between 2005 and 2016 in a single center. We analyzed midterm outcomes of early surgery (ES; surgery within 7 days or less of prior directed antibiotic treatment) in comparison to DS (surgery after more than 7 days of prior directed antibiotic treatment).

RESULTS

Survival of all patients was 87% at one and 72% at 5 years. Mean follow-up time was 4.0 ± 3.1 years. Thirty-three (36.3%) patients were in the ES and 58 (63.7%) were in the DS group. Patients with ES were younger (47.4 vs 55.3 years), were in New York Heart Association class III or IV more frequently (97.0 vs 65.5%), and had higher EuroScore2 (15.6 vs 8.6%). The ES group had lower freedom from valve reoperation (98.2 vs 87.2%; P = .035) and the composite endpoint of >2 + regurgitation or reoperation at 5 years (98.2 vs 72.7%; P = .004).

CONCLUSIONS

ES was associated with a higher rate of reoperations and the composite endpoint of recurrent MR or reoperation.

摘要

研究背景与目的

感染性心内膜炎的手术时机存在争议。本研究的目的是报告二尖瓣心内膜炎早期手术与延迟手术（DS）的结果。

方法

我们回顾性分析了2005年至2016年在单一中心接受二尖瓣心内膜炎手术治疗的所有患者。我们分析了早期手术（ES；在先前针对性抗生素治疗7天内或更短时间内进行手术）与DS（在先前针对性抗生素治疗超过7天后进行手术）的中期结果。

结果

所有患者1年生存率为87%，5年生存率为72%。平均随访时间为4.0±3.1年。33例（36.3%）患者接受ES，58例（63.7%）患者接受DS。接受ES的患者更年轻（47.4岁对55.3岁），纽约心脏协会III或IV级的比例更高（97.0%对65.5%），欧洲心脏手术风险评估系统2（EuroScore2）更高（15.6对8.6）。ES组瓣膜再次手术的自由度较低（98.2%对87.2%；P=0.035），5年时>2+反流或再次手术的复合终点较低（98.2%对72.7%；P=0.004）。