Van Hemelrijck Mathias, Sromicki Juri, Frank Michelle, Greutmann Matthias, Ledergerber Bruno, Epprecht Jana, Padrutt Maria, Vogt Paul R, Carrel Thierry P, Dzemali Omer, Mestres Carlos-A, Hasse Barbara
Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
Front Cardiovasc Med. 2023 Aug 24;10:1223878. doi: 10.3389/fcvm.2023.1223878. eCollection 2023.
Around 25% of patients with left-sided infective endocarditis and operative indication do not undergo surgery. Baseline characteristics and outcomes are underreported. This study describes characteristics and outcomes of surgical candidates with surgical intervention or medical treatment only.
Retrospective analysis of ongoing collected data from a single-center from an observational cohort of patients with infective endocarditis (ENVALVE). Kaplan-Meier estimates for survival was calculated. Factors associated with survival were assessed using a bivariable Cox model. To adjust for confounding by indication, uni- and multivariable logistic regression for the propensity to receive surgery were adjusted.
From January 2018 and December 2021, 154 patients were analyzed: 116 underwent surgery and 38 received medical treatment only. Surgical candidates without surgery were older (70 vs. 62 years, = 0.001). They had higher preoperative risk profile (EuroSCORE II 14% (7.2-28.6) vs. 5.8% (2.5-20.3), = 0.002) and more comorbidities. One patient was lost-to-follow-up. Survival analysis revealed a significant higher one-year survival rate among patients following surgery (83.7% vs. 15.3% in the non-surgical group; log-rank test <0.0001). In the final multivariable adjusted model, surgery was less likely among patients with liver cirrhosis [OR = 0.03 (95% CI 0.00-0.30)] and with hemodialysis [OR = 0.014 (95% CI 0.00-0.47)].
Patients with left-sided infective endocarditis who do not undergo surgery despite an operative indication are older, have more comorbidities and therefore higher preoperative risk profile and a low 1-year survival. The role of the Endocarditis Team may be particularly important for the decision-making process in this specific group.
约25%有手术指征的左侧感染性心内膜炎患者未接受手术。基线特征和预后情况报道不足。本研究描述了仅接受手术干预或药物治疗的手术候选患者的特征和预后。
对来自单中心感染性心内膜炎观察队列（ENVALVE）正在收集的数据进行回顾性分析。计算生存的Kaplan-Meier估计值。使用双变量Cox模型评估与生存相关的因素。为校正指征混杂因素，对接受手术倾向进行单变量和多变量逻辑回归调整。
2018年1月至2021年12月，分析了154例患者：116例接受了手术，38例仅接受了药物治疗。未接受手术的手术候选患者年龄更大（70岁对62岁，P = 0.001）。他们术前风险更高（欧洲心脏手术风险评估系统II 14%（7.2 - 28.6）对5.8%（2.5 - 20.3），P = 0.002）且合并症更多。1例患者失访。生存分析显示手术患者的1年生存率显著更高（83.7%对非手术组的15.3%；对数秩检验P < 0.0001）。在最终的多变量调整模型中，肝硬化患者[比值比（OR）= 0.03（95%置信区间0.00 - 0.30）]和接受血液透析的患者[OR = 0.014（95%置信区间0.00 - 0.47）]接受手术的可能性较小。
尽管有手术指征但未接受手术的左侧感染性心内膜炎患者年龄更大，合并症更多，因此术前风险更高且1年生存率较低。心内膜炎团队在这一特定群体的决策过程中可能尤为重要。
