Department of Cardiology, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario Valladolid, Valladolid, Spain
CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
Heart. 2021 Dec;107(24):1987-1994. doi: 10.1136/heartjnl-2021-319661. Epub 2021 Sep 11.
To evaluate the prognostic impact of urgent cardiac surgery on the prognosis of left-sided infective endocarditis (LSIE) and its relationship to the basal risk of the patient and to the surgical indication.
605 patients with LSIE and formal surgical indication were consecutively recruited between 2000 and 2020 among three tertiary centres: 405 underwent surgery during the active phase of the disease and 200 did not despite having indication. The prognostic impact of urgent surgery was evaluated by multivariable analysis and propensity score analysis. We studied the benefit of surgery according to baseline mortality risk defined by the ENDOVAL score and according to surgical indication.
Surgery is an independent predictor of survival in LSIE with surgical indication both by multivariable analysis (OR 0.260, 95% CI 0.162 to 0.416) and propensity score (mortality 40% vs 66%, p<0.001). Its greatest prognostic benefit is seen in patients at highest risk (predicted mortality 80%-100%: OR 0.08, 95% CI 0.021 to 0.299). The benefit of surgery is especially remarkable for uncontrolled infection indication (OR 0.385, 95% CI 0.194 to 0.765), even in combination with heart failure (OR 0.220, 95% CI 0.077 to 0.632).
Surgery during active LSIE seems to significantly reduce in-hospital mortality. The higher the risk, the higher the improvement in outcome.
评估紧急心脏手术对左侧感染性心内膜炎（LSIE）预后的影响及其与患者基础风险和手术适应证的关系。
2000 年至 2020 年期间，我们连续在三家三级中心招募了 605 例 LSIE 患者，并存在明确的手术适应证：405 例患者在疾病活动期接受了手术，200 例尽管有手术适应证但未进行手术。通过多变量分析和倾向评分分析评估紧急手术的预后影响。我们根据 ENDOVAL 评分定义的基线死亡率风险和手术适应证研究了手术的获益。
对于存在手术适应证的 LSIE 患者，手术是生存的独立预测因素，这在多变量分析（OR 0.260，95%CI 0.162 至 0.416）和倾向评分（死亡率 40%与 66%，p<0.001）中均有体现。其最大的预后获益见于风险最高的患者（预测死亡率 80%-100%：OR 0.08，95%CI 0.021 至 0.299）。对于未控制感染的手术适应证（OR 0.385，95%CI 0.194 至 0.765），甚至与心力衰竭（OR 0.220，95%CI 0.077 至 0.632）联合时，手术的获益尤其显著。
在 LSIE 活动期进行手术似乎可显著降低住院死亡率。风险越高，预后改善越明显。
