Department of Infectious Diseases, Hospital Clinic, August Pi I Sunyer Institute of Biomedical Research (IDIBAPS), University of Barcelona, Barcelona, Spain; Biomedical Network Research Center for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain.
Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain.
J Am Coll Cardiol. 2024 Apr 16;83(15):1418-1430. doi: 10.1016/j.jacc.2024.01.037.
During the past 6 decades, there have been numerous changes in prosthetic valve endocarditis (PVE), currently affecting an older population and increasing in incidence in patients with transcatheter-implanted valves. Significant microbiologic (molecular biology) and imaging diagnostic (fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography) advances have been incorporated into the 2023 Duke-International Society for Cardiovascular Infectious Diseases infective endocarditis diagnostic criteria, thus increasing the diagnostic sensitivity for PVE without sacrificing specificity in validation studies. PVE is a life-threatening disease requiring management by multidisciplinary endocarditis teams in cardiac centers to improve outcomes. Novel surgical options are now available, and an increasing set of patients may avoid surgical intervention despite indication. Selected patients may complete parenteral or oral antimicrobial treatment at home. Finally, patients with prosthetic valves implanted surgically or by the transcatheter approach are candidates for antibiotic prophylaxis before invasive dental procedures.
在过去的 60 年中，人工心脏瓣膜心内膜炎（PVE）发生了许多变化，目前影响的是老年人群体，并且经导管植入的瓣膜患者的发病率也在增加。重大的微生物学（分子生物学）和影像学诊断（氟-18 氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描）进展已被纳入 2023 年杜克-国际心血管感染性疾病学会感染性心内膜炎诊断标准，从而在验证研究中不牺牲特异性的情况下提高了 PVE 的诊断敏感性。PVE 是一种危及生命的疾病，需要心脏中心的多学科心内膜炎团队进行管理，以改善结局。现在有了新的手术选择，越来越多的患者即使有手术指征也可以避免手术干预。一些特定的患者可能可以在家中进行肠外或口服抗菌药物治疗。最后，植入人工心脏瓣膜的患者，无论是通过手术还是经导管介入的方法，都可以在接受侵入性牙科手术前进行抗生素预防。
