Arvay A, Lengyel M
Hungarian Institute of Cardiology, Budapest.
Eur J Cardiothorac Surg. 1988;2(5):340-6.
To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacements from 1 January 1981 to 31 December 1985 for 1-6 (mean 3) years. PVE occurred in 27 patients (2.96% or 0.98% per patient-year). The incidence of PVE in the aortic position (3.9%) was significantly higher than in the mitral position (1.5%): chi-square = 6.1, P less than 0.025. PVE developed in 19 of 329 patients with bioprostheses (5.8%), and in 8 of 583 patients with mechanical valves (1.4%): chi-square = 14.48, P less than 0.005). Actuarially at 5-year follow-up, 90.7% +/- 2.16% of the bioprosthetic group and 98.4% +/- 0.56% of the mechanical valve group was free of PVE (P less than 0.001). Antecedent endocarditis increased both the incidence and relative risk of PVE 7-fold compared to patients without antecedent endocarditis (chi-square = 32.0, P less than 0.0001). Bioprosthetic valve replacement in infective endocarditis increased the risk of PVE 12-fold compared to valve replacement by mechanical prostheses.
in the order of importance, antecedent endocarditis, bioprostheses and aortic position are risk factors in the development of PVE. Bioprostheses implanted in patients with antecedent endocarditis further enhance the risk of PVE.
为研究人工瓣膜心内膜炎（PVE）的发病率及危险因素，我们对1981年1月1日至1985年12月31日期间接受瓣膜置换术的912例患者中的99.5%进行了为期1至6年（平均3年）的随访。27例患者发生了PVE（2.96%，即每年每患者0.98%）。主动脉瓣位PVE的发病率（3.9%）显著高于二尖瓣位（1.5%）：卡方检验=6.1，P<0.025。329例生物瓣置换患者中有19例发生PVE（5.8%），583例机械瓣置换患者中有8例发生PVE（1.4%）：卡方检验=14.48，P<0.005。经精算，5年随访时，生物瓣组90.7%±2.16%无PVE，机械瓣组98.4%±0.56%无PVE（P<0.001）。与无前驱心内膜炎的患者相比，前驱心内膜炎使PVE的发病率和相对风险增加了7倍（卡方检验=32.0，P<0.0001）。感染性心内膜炎患者行生物瓣置换与机械瓣置换相比，PVE风险增加了12倍。
按重要性排序，前驱心内膜炎、生物瓣和主动脉瓣位是PVE发生的危险因素。感染前驱心内膜炎患者植入生物瓣会进一步增加PVE风险。
