感染性心内膜炎合并术前脓毒性脑栓塞患者心脏瓣膜手术后的结局：来自 CAMPAIGN 研究组的见解。

Outcomes following heart valve surgery in patients with infective endocarditis and preoperative septic cerebral embolism: insights from the CAMPAIGN study group.

机构信息

University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany.

出版信息

Eur J Cardiothorac Surg. 2024 Aug 2;66(2). doi: 10.1093/ejcts/ezae295.

DOI:10.1093/ejcts/ezae295

PMID:39087593

Abstract

OBJECTIVES

This study aimed to analyse the impact of preoperative septic cerebral embolism on early and late postoperative outcomes in patients with infective endocarditis undergoing valve surgery.

METHODS

Retrospective multicentric study based on the Clinical Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry comprising patients with infective endocarditis who underwent valve surgery between 1994 and 2018 at 6 German centres. Patients were divided into 2 groups for statistical comparison according to the presence or absence of preoperative septic cerebral embolism. Propensity score matching was performed for adjusted comparisons of postoperative outcomes. Primary outcomes were 30-day mortality and estimated 5-year survival.

RESULTS

A total of 4917 patients were included in the analysis, 3909 (79.5%) patients without and 1008 (20.5%) patients with preoperative septic cerebral embolism. Patients with preoperative septic cerebral embolism had more baseline comorbidities. Mitral valve endocarditis (44.1% vs 33.0% P < 0.001), large vegetations >10 mm (43.1% vs 30.0%, P < 0.001), and Staphylococcus species infection (42.3% vs 21.3%, P < 0.001) were more frequent in the cerebral embolism group. Among patients with preoperative cerebral embolism, 286 (28.4%) patients had no stroke signs (silent stroke). After matching (1008 matched pairs), there was no statistically significant difference in 30-day mortality (20.1% vs 22.8%; P = 0.14) and 5-year survival (47.8% vs 49.1%; stratified log-rank P = 0.77) in patients with and without preoperative cerebral embolism, respectively.

CONCLUSIONS

Preoperative septic cerebral embolism in patients with infective endocarditis requiring valve surgery does not negatively affect early or late mortality; therefore, it should not play a major role in deciding if surgery is to be performed.

摘要

目的

本研究旨在分析术前脓毒性脑栓塞对行瓣膜手术的感染性心内膜炎患者早期和晚期术后结局的影响。

方法

这是一项基于德国临床多中心感染性心内膜炎分析项目（CAMPAIGN）注册研究的回顾性多中心研究，纳入了 1994 年至 2018 年间在德国 6 家中心行瓣膜手术的感染性心内膜炎患者。根据术前是否存在脓毒性脑栓塞，将患者分为两组进行统计学比较。采用倾向评分匹配法对术后结局进行调整比较。主要结局为 30 天死亡率和估计的 5 年生存率。

结果

共纳入 4917 例患者，其中 3909 例（79.5%）患者无术前脓毒性脑栓塞，1008 例（20.5%）患者有术前脓毒性脑栓塞。术前脓毒性脑栓塞患者基线合并症更多。二尖瓣心内膜炎（44.1%比 33.0%，P<0.001）、大赘生物>10 mm（43.1%比 30.0%，P<0.001）和葡萄球菌感染（42.3%比 21.3%，P<0.001）在脑栓塞组更常见。在有术前脑栓塞的患者中，286 例（28.4%）患者无脑卒体征（无症状性卒中）。匹配后（1008 对匹配），术前有或无脑栓塞的患者 30 天死亡率（20.1%比 22.8%；P=0.14）和 5 年生存率（47.8%比 49.1%；分层对数秩 P=0.77）差异均无统计学意义。