Nel Riaan, Janson Jacques, Esterhuizen Tonya, van der Westhuizen Clinton
Division of Cardiothoracic Surgery, Stellenbosch University and Tygerberg Academic Hospital, Cape Town 7505, South Africa.
Division of Epidemiology and Biostatistics, Stellenbosch University, Cape Town 7505, South Africa.
J Clin Med. 2024 Sep 3;13(17):5226. doi: 10.3390/jcm13175226.
There is a paucity of data on the outcome of left-sided cardiac valve surgery for infective endocarditis in South Africa. It is hypothesized that outcomes may be poorer compared to international standards due to differences in disease burden, timing of surgery, organism prevalence, and co-morbidities. This is a retrospective study of 160 patients with left heart valve endocarditis who underwent cardiac surgery from January 2010 to December 2019. Demographic, operative, and admission-related parameters were assessed to determine their association with all-cause mortality during the early post-operative (<30 days) and late post-operative (>30 days) periods. Early post-operative mortality (<30 days) was 8.8% and late post-operative mortality (>30 days) was 13.1%. Late survival showed 77.5% of the patients were alive with a mean follow-up period of 41 months. Increased age ( = 0.04), critical illness ( < 0.001), and higher urgency of intervention ( < 0.001) were associated with higher early post-operative mortality. Peri-operative organ failure, including cardiac ( = 0.025), renal ( = 0.016), and respiratory failure ( < 0.001), contributed significantly to both early and late mortality. Pre-operative antibiotics for fewer days ( = 0.024), ongoing sepsis ( = 0.022), and para-valvular extension ( = 0.046) were associated with higher early mortality. Infective endocarditis is a common indication for cardiac valve surgery in South Africa. Goal-directed medical management and clinical optimization prior to surgery were crucial to achieving better outcomes. Salvage procedures and critical illness with organ failure prior to surgery were associated with poorer outcomes. Despite unique challenges, cardiac surgery for infective endocarditis at Tygerberg Hospital compares favorably to international standards.
在南非，关于感染性心内膜炎左侧心脏瓣膜手术结果的数据匮乏。据推测，由于疾病负担、手术时机、病原体流行情况和合并症的差异，与国际标准相比，其结果可能更差。这是一项对2010年1月至2019年12月期间接受心脏手术的160例左心瓣膜心内膜炎患者的回顾性研究。评估了人口统计学、手术和入院相关参数，以确定它们与术后早期（<30天）和术后晚期（>30天）全因死亡率的关联。术后早期死亡率（<30天）为8.8%，术后晚期死亡率（>30天）为13.1%。晚期生存率显示，77.5%的患者存活，平均随访期为41个月。年龄增加（P = 0.04）、危重病（P < 0.001）和更高的干预紧迫性（P < 0.001）与术后早期死亡率较高相关。围手术期器官衰竭，包括心脏（P = 0.025）、肾脏（P = 0.016）和呼吸衰竭（P < 0.001），对早期和晚期死亡率都有显著影响。术前使用抗生素天数较少（P = 0.024）、持续脓毒症（P = 0.022）和瓣周扩展（P = 0.046）与早期死亡率较高相关。感染性心内膜炎是南非心脏瓣膜手术的常见适应症。术前目标导向的医疗管理和临床优化对于取得更好的结果至关重要。挽救性手术和术前伴有器官衰竭的危重病与较差的结果相关。尽管存在独特的挑战，但泰格堡医院感染性心内膜炎的心脏手术与国际标准相比仍具有优势。
