Croft C H, Woodward W, Elliott A, Commerford P J, Barnard C N, Beck W
Am J Cardiol. 1983 Jun;51(10):1650-5. doi: 10.1016/0002-9149(83)90203-5.
From 1972 to 1980, 23 patients (Group A) with native valve infective endocarditis underwent surgical intervention, often for multiple indications, during the active stage of the infective process because of progressive class III and IV (New York Heart Association) heart failure (12 patients), persistent severe hypotension (3 patients), uncontrolled infection for over 21 days (11 patients), aortic root abscess (2 patients), and pericarditis (1 patient). Eighty-five patients (Group B) with active native valve endocarditis, matched for severity of illness, were treated medically. Two patients (9%) in Group A and 43 patients (51%) in Group B died during the hospital admission (p less than 0.001). Any difference in long-term cumulative survival rate between the 2 groups was largely due to the beneficial impact of surgical management on the hospital mortality. Of 23 patients in Group A, 11 (48%) had an entirely uncomplicated postoperative course. Long-term mortality rates in those with aortic valve endocarditis treated medically (79%) were significantly higher than in those with mitral valve involvement (47%) (p less than 0.05). Patients with aortic valve involvement treated surgically had a better hospital (p less than 0.005) and long-term (p less than 0.0005) survival rate than those treated medically. Two groups at risk for postoperative complications were identified; 3 of 11 patients (27%) with uncontrolled infection had an early postoperative recurrence, and 4 of 7 patients (57%) with an aortic root abscess had postoperative prosthetic paravalvular regurgitation. Surgery therefore effects a substantial reduction in hospital mortality in patients with complicated active infective endocarditis (9% versus 51%), but patients with preoperative prolonged periods of uncontrolled infection or with aortic root abscess are liable to postoperative complications.
1972年至1980年期间，23例（A组）天然瓣膜感染性心内膜炎患者在感染活动期因纽约心脏协会III级和IV级进行性心力衰竭（12例）、持续性严重低血压（3例）、超过21天的未控制感染（11例）、主动脉根部脓肿（2例）和心包炎（1例）等多种指征接受了手术干预。85例（B组）病情严重程度匹配的活动性天然瓣膜心内膜炎患者接受了药物治疗。A组2例（9%）患者和B组43例（51%）患者在住院期间死亡（p<0.001）。两组长期累积生存率的任何差异在很大程度上归因于手术治疗对医院死亡率的有益影响。A组23例患者中，11例（48%）术后病程完全无并发症。药物治疗的主动脉瓣心内膜炎患者的长期死亡率（79%）显著高于二尖瓣受累患者（47%）（p<0.05）。接受手术治疗的主动脉瓣受累患者的医院生存率（p<0.005）和长期生存率（p<0.0005）均优于药物治疗患者。确定了两组有术后并发症风险的患者；11例未控制感染患者中有3例（27%）术后早期复发，7例主动脉根部脓肿患者中有4例（57%）术后出现人工瓣膜瓣周反流。因此，手术可显著降低复杂性活动性感染性心内膜炎患者的医院死亡率（9%对51%），但术前长期未控制感染或有主动脉根部脓肿的患者易发生术后并发症。
