Kilic Arman, Huckaby Lauren V, Hong Yeahwa, Sultan Ibrahim, Aranda-Michel Edgar, Thoma Floyd, Wang Yisi, Navid Forozan, Gleason Thomas G
Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
J Card Surg. 2020 Oct;35(10):2725-2733. doi: 10.1111/jocs.14893. Epub 2020 Aug 25.
This study evaluated surgical outcomes of infective endocarditis (IE), with particular attention to the impact of intravenous drug use (IVDU).
Adult patients undergoing surgery for IE between 2011 and 2018 at a single center were included and stratified by IVDU. The primary outcome was overall survival. Secondary outcomes included postoperative complications and hospital readmissions. Kaplan-Meier and multivariable Cox regression were utilized for unadjusted and risk-adjusted survival analyses, respectively. Cumulative incidence function curves were compared for hospital readmissions.
A total of 831 patients (mean age 55 years, 34.4% female) were operated on for IE, including 318 (38.3%) with IVDU. Cultures were most commonly positive for streptococcus (25.2%), methicillin-sensitive Staphylococcus aureus (17.7%), enterococcus (14.3%), or methicillin-resistant Staphylococcus aureus (8.4%). The most common procedures included isolated aortic valve repair/replacement (18.8%), aortic root replacement (15.9%), mitral valve repair/replacement (26.7%), aortic and mitral valve replacement (8.4%), and tricuspid valve repair/replacement (7.6%). Mean follow-up was 3.4 ± 2.4 years. Overall 5-year survival was 64% and was similar between IVDU and non-IVDU. Multivariable analysis demonstrated that IVDU was not associated with mortality risk. IVDU patients displayed higher rates of all-cause readmission (61.6% vs 53.9%; P = .03), drug-use readmission (15.4% vs 1.4%; P < .001), and recurrent endocarditis readmission (33.0% vs 13.0%; P < .001).
The majority of patients undergoing surgical treatment of IE are alive at 5-years although readmission rates are high. IVDU is not a risk factor for longitudinal mortality although patients with IVDU are at higher overall readmission risk, driven largely by greater readmissions for drug-use and recurrent endocarditis.
本研究评估了感染性心内膜炎（IE）的手术结果，特别关注静脉药物使用（IVDU）的影响。
纳入2011年至2018年在单一中心接受IE手术的成年患者，并按IVDU进行分层。主要结局是总生存率。次要结局包括术后并发症和再次入院情况。分别采用Kaplan-Meier法和多变量Cox回归进行未调整和风险调整的生存分析。比较再次入院的累积发病率函数曲线。
共有831例患者（平均年龄55岁，34.4%为女性）接受了IE手术，其中318例（38.3%）有IVDU。培养物最常见的阳性菌为链球菌（25.2%）、甲氧西林敏感金黄色葡萄球菌（17.7%）、肠球菌（14.3%）或甲氧西林耐药金黄色葡萄球菌（8.4%）。最常见的手术包括单纯主动脉瓣修复/置换（18.8%）、主动脉根部置换（15.9%）、二尖瓣修复/置换（26.7%）、主动脉瓣和二尖瓣置换（8.4%）以及三尖瓣修复/置换（7.6%）。平均随访时间为3.4±2.4年。总体5年生存率为64%，IVDU组和非IVDU组相似。多变量分析表明，IVDU与死亡风险无关。IVDU患者的全因再次入院率（61.6%对53.9%；P = 0.03）、药物使用再次入院率（15.4%对1.4%；P < .001）和复发性心内膜炎再次入院率（33.0%对13.0%；P < .001）更高。
尽管再次入院率较高，但大多数接受IE手术治疗的患者5年后仍存活。IVDU不是长期死亡的危险因素，尽管IVDU患者的总体再次入院风险较高，主要是由药物使用和复发性心内膜炎导致的更高再次入院率所致。
