Calderwood S B, Swinski L A, Karchmer A W, Waternaux C M, Buckley M J
J Thorac Cardiovasc Surg. 1986 Oct;92(4):776-83.
We analyzed the outcome of 116 patients with prosthetic valve endocarditis treated between 1975 and 1983 and used multivariate analysis to identify risk factors for in-hospital mortality and bad outcome during follow-up. Complicated prosthetic valve endocarditis was defined as the presence of a new or changing heart murmur, new or worsening heart failure, new or progressive cardiac conduction abnormalities, or prolonged fever during therapy. Complicated prosthetic valve endocarditis was present in 64% of patients; factors associated with complicated prosthetic valve endocarditis included aortic valve infection (odds ratio 4.3, p = 0.002) and onset of endocarditis within 12 months of the cardiac operation (odds ratio 5.5, p = 0.0001). The in-hospital mortality rate for prosthetic valve endocarditis was 23%; patients with complicated prosthetic valve endocarditis had a higher mortality than patients with uncomplicated infection (odds ratio 6.4, p = 0.0009). Combined medical-surgical therapy was used in 39% of patients; surgical therapy was more common in patients with complicated prosthetic valve endocarditis (odds ratio 16, p less than 0.0001) and in patients infected with coagulase-negative staphylococci (odds ratio 3.9, p = 0.003). Survival after initially successful therapy for prosthetic valve endocarditis was adversely affected by the presence of moderate or severe congestive heart failure at hospital discharge (p = 0.03). Bad outcome during follow-up (death, relapse of prosthetic valve endocarditis, or subsequent cardiac operation related to sequelae of the original infection) was more common in the medical than the medical-surgical therapy group (p = 0.02). The difference in long-term outcome between patients treated initially with medical or with medical-surgical therapy was particularly evident in those with complicated prosthetic valve endocarditis (p = 0.008). The presence of complicated prosthetic valve endocarditis is a central variable in assessing prognosis and planning therapy; the majority of patients with complicated prosthetic valve endocarditis are best treated with medical-surgical therapy. Those who are not treated surgically during their initial hospitalization are at high risk for progressive prosthesis dysfunction and require careful follow-up.
我们分析了1975年至1983年间接受人工瓣膜心内膜炎治疗的116例患者的治疗结果，并采用多因素分析来确定住院死亡率和随访期间不良结局的危险因素。复杂性人工瓣膜心内膜炎定义为出现新的或变化的心脏杂音、新的或恶化的心力衰竭、新的或进行性心脏传导异常，或治疗期间持续发热。64%的患者存在复杂性人工瓣膜心内膜炎；与复杂性人工瓣膜心内膜炎相关的因素包括主动脉瓣感染（比值比4.3，p = 0.002）和心脏手术后12个月内发生心内膜炎（比值比5.5，p = 0.0001）。人工瓣膜心内膜炎的住院死亡率为23%；复杂性人工瓣膜心内膜炎患者的死亡率高于非复杂性感染患者（比值比6.4，p = 0.0009）。39%的患者采用了内科-外科联合治疗；外科治疗在复杂性人工瓣膜心内膜炎患者中更为常见（比值比16，p < 0.0001），在凝固酶阴性葡萄球菌感染患者中也更为常见（比值比3.9，p = 0.003）。人工瓣膜心内膜炎初始治疗成功后，出院时存在中度或重度充血性心力衰竭会对生存产生不利影响（p = 0.03）。随访期间的不良结局（死亡、人工瓣膜心内膜炎复发或随后因原感染后遗症进行的心脏手术）在内科治疗组比在内科-外科联合治疗组中更常见（p = 0.02）。最初接受内科治疗或内科-外科联合治疗的患者在长期结局上的差异在复杂性人工瓣膜心内膜炎患者中尤为明显（p = 0.008）。复杂性人工瓣膜心内膜炎的存在是评估预后和制定治疗方案的核心变量；大多数复杂性人工瓣膜心内膜炎患者最好采用内科-外科联合治疗。那些在初次住院期间未接受手术治疗的患者发生人工瓣膜功能进行性障碍的风险很高，需要密切随访。
