Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia.
Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
J Thorac Cardiovasc Surg. 2019 Nov;158(5):1399-1409. doi: 10.1016/j.jtcvs.2019.06.024. Epub 2019 Jun 20.
Infective endocarditis (IE) is rare in children. Limited data have been reported on long-term outcomes of children who undergo surgery for IE.
Data were retrospectively obtained from medical records for all children who underwent surgery for IE.
Between 1987 and 2017, 138 children with IE required surgery (mean age, 8.3 ± 6.5 years). The majority of children (80.4% [111 out of 138]) had underlying cardiac structural anomalies. Prior heart surgery was performed in 50.7% of patients (70 out of 138), including 19.6% (27 out of 138) who had valve replacement. Operative mortality was 5.8% (8 out of 138). Mean follow-up time was 9.7 ± 7.6 years. Long-term survival at 5 and 25 years was 91.5% (95% confidence interval, 85.1%-95.2%) and 79.1% (95% confidence interval, 66.3%-87.5%), respectively. Risk factors associated with death were: age (hazard ratio [HR], 0.88; P = .015), prosthetic valve IE (HR, 3.86; P = .02), coagulase-negative staphylococci (HR, 4.52; P = .015), increased duration of preoperative antibiotic therapy (HR, 1.02; P = .009), shock (HR, 3.68; P = .028), and aortic valve replacement (HR, 3.22; P = .044). In patients with left-sided IE, risk factors independently associated with death were heart failure (HR, 18.8; P = .025) and vegetation size adjusted to body surface area (HR, 1.06; P = .008). Freedom from recurrent endocarditis was 94.7% (95% confidence interval, 87.7%-97.8%) at 25 years.
Children undergoing surgery for IE had good long-term survival and recurrence of IE was uncommon. Surgery during the active phase of endocarditis did not increase risk of mortality or reoperation. In patients with left-sided IE, vegetation size adjusted for patient body surface area was identified as a risk factor for death, and a useful indicator of prognosis.
感染性心内膜炎（IE）在儿童中较为罕见。目前关于接受 IE 手术治疗的儿童长期预后的数据有限。
从病历中回顾性获取所有接受 IE 手术治疗的儿童的数据。
在 1987 年至 2017 年间，共有 138 例 IE 患儿接受手术治疗（平均年龄 8.3±6.5 岁）。大多数患儿（80.4%[111/138]）存在心脏结构异常。50.7%的患儿（138 例中有 70 例）接受过先前的心脏手术，包括 19.6%（138 例中有 27 例）接受过瓣膜置换术。手术死亡率为 5.8%（138 例中有 8 例）。平均随访时间为 9.7±7.6 年。5 年和 25 年的长期生存率分别为 91.5%（95%置信区间，85.1%-95.2%）和 79.1%（95%置信区间，66.3%-87.5%）。与死亡相关的危险因素包括：年龄（风险比[HR]，0.88；P=.015）、人工瓣膜 IE（HR，3.86；P=.02）、凝固酶阴性葡萄球菌（HR，4.52；P=.015）、术前抗生素治疗时间延长（HR，1.02；P=.009）、休克（HR，3.68；P=.028）和主动脉瓣置换术（HR，3.22；P=.044）。在左侧 IE 患儿中，与死亡独立相关的危险因素为心力衰竭（HR，18.8；P=.025）和根据体表面积校正的赘生物大小（HR，1.06；P=.008）。25 年时，无复发性心内膜炎的发生率为 94.7%（95%置信区间，87.7%-97.8%）。
接受 IE 手术治疗的儿童长期生存率良好，IE 复发罕见。IE 活动期手术并不会增加死亡率或再次手术的风险。在左侧 IE 患儿中，根据患者体表面积校正的赘生物大小被确定为死亡的危险因素，是一个有用的预后指标。
