活动性感染性天然瓣膜和人工瓣膜心内膜炎：手术治疗后患者的短期和长期结局
Active Infective Native and Prosthetic Valve Endocarditis: Short- and Long-Term Outcomes of Patients after Surgical Treatment.
作者信息
Salem Mohamed, Friedrich Christine, Saad Mohammed, Frank Derk, Salem Mostafa, Puehler Thomas, Schoettler Jan, Schoeneich Felix, Cremer Jochen, Haneya Assad
机构信息
Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany.
Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, Arnold-Heller-Str. 3, D-24105 Kiel, Germany.
出版信息
J Clin Med. 2021 Apr 26;10(9):1868. doi: 10.3390/jcm10091868.
BACKGROUND
Active infective endocarditis (IE) is a serious disease associated with high mortality. The current study represents our experience over 18 years with surgical treatment for active infective native and prosthetic valve endocarditis (INVE, IPVE).
METHOD
Analysis of 413 patients (171 with IPVE vs. 242 with INVE) who underwent cardiac surgery due to IE between 2002 and 2020.
RESULTS
Patients with IPVE were significantly older (64.9 ± 13.2 years vs. 58.3 ± 15.5 years; < 0.001) with higher EuroSCORE II (21.2 (12.7; 41.8) vs. 6.9 (3.0; 17.0); < 0.001)) and coronary heart disease (50.6% vs. 38.0%; < 0.011). Preoperative embolization was significantly higher within INVE (35.5% vs. 16.4%; < 0.001) with high incidence of cerebral embolization (18.6% vs. 7.6%; = 0.001) and underwent emergency curative surgery than the IPVE group (19.6% vs. 10.6%; < 0.001). However, patients with IPVE were significantly represented with intracardiac abscess (44.4% vs.15.7%; < 0.001). Intraoperatively, the duration of surgery was expectedly significantly higher in the IPVE group (356 min vs. 244 min.; = 0.001) as well as transfusion of blood (4 units (0-27) vs. 2 units (0-14); < 0.001). Post-operatively, the incidence of bleeding was markedly higher within the IPVE group (700 mL (438; 1163) vs. 500 mL (250; 1075); = 0.005). IPVE required significantly more permanent pacemakers (17.6% vs. 7.5%: = 0.002). The 30-day mortality was higher in the IPVE group (24.6% vs. 13.2%; < 0.003).
CONCLUSION
Patients with INVE suffered from a higher incidence of cerebral embolization and neurological deficits than patients with IPVE. Surgical treatment in INVE is performed mostly as an emergency indication. However, patients with IPVE were represented commonly with intracardiac abscess, and had a higher indication of pacemaker implantation. The short- and long-term mortality rate among those patients was still high.
背景
活动性感染性心内膜炎（IE）是一种死亡率很高的严重疾病。本研究展示了我们18年来对活动性感染性自体瓣膜和人工瓣膜心内膜炎（INVE、IPVE）进行手术治疗的经验。
方法
分析2002年至2020年间因IE接受心脏手术的413例患者（171例IPVE患者与242例INVE患者）。
结果
IPVE患者年龄显著更大（64.9±13.2岁 vs. 58.3±15.5岁；P<0.001），欧洲心脏手术风险评估系统（EuroSCORE）II评分更高（21.2（12.7；41.8） vs. 6.9（3.0；17.0）；P<0.001），冠心病患病率更高（50.6% vs. 38.0%；P<0.011）。术前栓塞在INVE患者中显著更常见（35.5% vs. 16.4%；P<0.001），脑栓塞发生率高（18.6% vs. 7.6%；P=0.001），且接受急诊根治性手术的比例高于IPVE组（19.6% vs. 10.6%；P<0.001）。然而，IPVE患者中心内脓肿的比例显著更高（44.4% vs. 15.7%；P<0.001）。术中，IPVE组手术时间预期显著更长（356分钟 vs. 244分钟；P=0.001），输血量也更多（4单位（0 - 27） vs. 2单位（0 - 14）；P<0.001）。术后，IPVE组出血发生率显著更高（700毫升（438；1163） vs. 500毫升（250；1075）；P=0.005）。IPVE患者需要更多的永久性起搏器（17.6% vs. 7.5%：P=0.002）。IPVE组30天死亡率更高（24.6% vs. 13.2%；P<0.003）。
结论
与IPVE患者相比，INVE患者脑栓塞和神经功能缺损的发生率更高。INVE的手术治疗大多作为急诊指征进行。然而，IPVE患者常合并心内脓肿，起搏器植入指征更高。这些患者的短期和长期死亡率仍然很高。
Zotero 插件