Yaftian Nima, Buratto Edward, Ye Xin Tao, Wilson Andrew, Darby Jonathan, Newcomb Andrew
Department of Cardiothoracic Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2020 May;90(5):757-761. doi: 10.1111/ans.15814. Epub 2020 Mar 16.
Infective endocarditis (IE) of the mitral valve is an illness associated with significant morbidity and mortality. We describe the long-term outcomes of mitral valve endocarditis at a single centre.
All patients who presented with IE to the study institution between 2000 and 2015 were included. Data were obtained by retrospective review of the medical records.
There were 163 patients who presented with mitral valve IE. Mean age was 58 ± 16.8 years. A history of intravenous drug use was present in 18% (30/163) of patients. The most common infective agents were Staphylococcus aureus in 42% (69/163) (7% (5/69) were methicillin resistant), Streptococcus viridans species in 15% (25/163) and Enterococcus faecalis in 10% (17/163). Surgery was performed in 29% (47/163) of patients. Hospital mortality was 23% (38/163). Survival was 71% (95% confidence interval (CI) 63.1-77.6%) at 1 year, 56% (95% CI 46.0-64.9%) at 5 years and 44% (95% CI 36.4-59.7%) at 10 years follow-up. There was no survival difference between medical and surgical management (P = 0.55). On multivariate Cox regression analysis, need for renal replacement therapy (P = 0.003) and increasing age (P = 0.014) were found to be risk factors while infectious diseases consult during index admission (P = 0.007) was found to be protective.
Mitral valve endocarditis is associated with survival of <50% at 10 years follow-up. Surgical and medical management were associated with similar outcomes. Increasing age and need for renal replacement therapy were associated with mortality, and infectious diseases consultation was associated with improved survival.
二尖瓣感染性心内膜炎（IE）是一种与高发病率和死亡率相关的疾病。我们描述了单中心二尖瓣心内膜炎的长期预后。
纳入2000年至2015年间在研究机构出现IE的所有患者。通过回顾病历获取数据。
有163例患者出现二尖瓣IE。平均年龄为58±16.8岁。18%（30/163）的患者有静脉吸毒史。最常见的感染病原体是金黄色葡萄球菌，占42%（69/163）（其中7%（5/69）对甲氧西林耐药），草绿色链球菌占15%（25/163），粪肠球菌占10%（17/163）。29%（47/163）的患者接受了手术。医院死亡率为23%（38/163）。随访1年时生存率为71%（95%置信区间（CI）63.1 - 77.6%），5年时为56%（95%CI 46.0 - 64.9%），10年时为44%（95%CI 36.4 - 59.7%）。药物治疗和手术治疗之间的生存率无差异（P = 0.55）。多因素Cox回归分析发现，需要肾脏替代治疗（P = 0.003）和年龄增长（P = 0.014）是危险因素，而在首次入院时进行传染病会诊（P = 0.007）是保护因素。
二尖瓣心内膜炎在随访10年时生存率低于50%。手术治疗和药物治疗的预后相似。年龄增长和需要肾脏替代治疗与死亡率相关，而传染病会诊与生存率提高相关。
