感染性心内膜炎与二尖瓣置换术的预后。

Infective endocarditis and outcomes of mitral valve replacement.

机构信息

Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Department of Public Health, University of Turku, Turku, Finland.

出版信息

Eur J Clin Invest. 2021 Sep;51(9):e13577. doi: 10.1111/eci.13577. Epub 2021 May 1.

DOI:10.1111/eci.13577

PMID:33931874

Abstract

BACKGROUND

We investigated the long-term outcomes of mitral valve replacement (MVR) in native mitral valve infective endocarditis (IE).

METHODS

Multicentre, population-based cohort register study consisted of 1233 consecutive adult patients treated with first-time MVR in Finland. Mitral valve IE was diagnosed in 170 of these patients. Propensity score matching resulted in 134 pairs with balanced baseline characteristics. The median follow-up was 6.1 years.

RESULTS

Pre-operative native mitral valve IE was associated with an increased hazard of 10-year mortality (38.8% vs 30.5%; HR 2.13; CI 1.17-3.85; P = .013) after MVR. Occurrence of major bleeding was higher in IE patients (26.0%) vs non-IE patients (23.4%) during the 10-year follow-up (HR 2.80; CI 1.01-7.77; P = .048). Hospital admission duration after MVR was longer in IE patients (median 28 vs 11 days; P < .0001). Cumulative ischaemic stroke rate was similar between patient groups (12.1% in IE vs 15.1% in non-IE; P = .493). Re-sternotomy was performed in 13.4% of IE patients and 9.0% of non-IE patients (P = .261).

CONCLUSIONS

Patients with native mitral valve IE have a higher risk of death and major bleeding after MVR than matched patients without IE. Results highlight the importance of complication prevention in these patients.

摘要

背景

我们研究了原发性二尖瓣感染性心内膜炎（IE）患者行二尖瓣置换术（MVR）的长期预后。

方法

这是一项多中心、基于人群的队列注册研究，纳入了 1233 例在芬兰首次接受 MVR 治疗的成年患者。其中 170 例患者被诊断为二尖瓣 IE。通过倾向评分匹配得到 134 对具有平衡基线特征的患者。中位随访时间为 6.1 年。

结果

MVR 后，术前原发性二尖瓣 IE 患者的 10 年死亡率显著升高（38.8% vs 30.5%；HR 2.13；95%CI 1.17-3.85；P =.013）。IE 患者在 10 年随访期间发生大出血的风险更高（26.0% vs 非 IE 患者 23.4%）（HR 2.80；95%CI 1.01-7.77；P =.048）。IE 患者 MVR 后的住院时间更长（中位数 28 天 vs 11 天；P <.0001）。两组患者的累积缺血性中风发生率相似（IE 组 12.1% vs 非 IE 组 15.1%；P =.493）。IE 患者中有 13.4%需要再次开胸，而非 IE 患者中有 9.0%需要再次开胸（P =.261）。