Keijmel Stephan P, Zwartkruis Iris M M, Jongenotter Jochem, Geuzebroek Guillaume S C, Kouijzer Ilse J E
Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Open Forum Infect Dis. 2023 Jan 13;10(1):ofad015. doi: 10.1093/ofid/ofad015. eCollection 2023 Jan.
Fever after cardiac surgery is common. More knowledge of postoperative fever could lead to better patient selection for diagnostic workup and empirical antibiotic treatment. We aimed to analyze the postoperative course of inflammation and fever after elective aortic valve and aortic root replacement.
In a retrospective single-center cohort study, we included 3 groups of patients after elective cardiac surgery: aortic root with aortic valve replacement (Bentall procedure, from 2014 to 2021), valve-sparing root replacement (VSRR, from 2014 to 2021), and isolated surgical aortic valve replacement (SAVR, from 2018 to 2021). Exclusion criteria were age <18 years, cardiac surgery other than described, use of deep-hypothermic circulatory arrest, reoperations, and preexisting infections. Primary outcome measure was the number of patients per group with postoperative fever (≥38°C). Secondary outcome measures were the percentage of patients per group with infections and outcome.
Among 307 patients included (76 Bentall, 40 VSRR, 191 SAVR), 71% had postoperative fever. Fever occurred significantly more often in the Bentall (84%) and VSRR group (83%) compared with patients after SAVR (64%, = .001). Seventeen patients had fever due to infection versus 202 with diagnoses of postoperative inflammation. In case of infection, fever was significantly higher (38.8°C vs 38.4°C, = .03), and both the number of days with fever and hospital admission duration were significantly longer.
Postoperative fever is more often observed after Bentall procedure and VSRR compared to SAVR. In diagnoses of infection, there is a higher and prolonged fever.
心脏手术后发热很常见。对术后发热有更多了解有助于更好地选择患者进行诊断检查和经验性抗生素治疗。我们旨在分析择期主动脉瓣和主动脉根部置换术后炎症和发热的病程。
在一项回顾性单中心队列研究中，我们纳入了择期心脏手术后的3组患者：主动脉根部置换并主动脉瓣置换（Bentall手术，2014年至2021年）、保留瓣膜的根部置换术（VSRR，2014年至2021年）以及单纯外科主动脉瓣置换术（SAVR，2018年至2021年）。排除标准为年龄<18岁、所述以外的心脏手术、使用深低温循环停搏、再次手术以及既往感染。主要结局指标是每组术后发热（≥38°C）的患者数量。次要结局指标是每组感染患者的百分比及结局。
在纳入的307例患者中（76例Bentall手术、40例VSRR、191例SAVR），71%有术后发热。与SAVR术后患者相比，Bentall组（84%）和VSRR组（83%）发热更为常见（64%，P = 0.001）。17例患者因感染发热，202例诊断为术后炎症。发生感染时，体温明显更高（38.8°C对38.4°C，P = 0.03），发热天数和住院时间均明显更长。
与SAVR相比，Bentall手术和VSRR术后更常观察到术后发热。在感染诊断中，发热更高且持续时间更长。
