Richardson J V, Karp R B, Kirklin J W, Dismukes W E
Circulation. 1978 Oct;58(4):589-97. doi: 10.1161/01.cir.58.4.589.
The results of surgical and non-surgical treatment of active infective endocarditis in 182 patients over a 10-year period were analyzed. Heart failure, annular and myocardial abscesses, heart block, and coronary embolism, seen most frequently with staphylococcal and fungal endocarditis, were the primary causes of death in both native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). In NVE, surgery significantly improved the survival in patients with moderate or severe heart failure (P less than 0.05) and in all patients with staphylococcal endocarditis (P less than 0.03). In PVE, surgery significantly influenced survival in patients with moderate or severe heart failure (P less than 0.05) and in the entire group with late PVE (P less than 0.01). Early surgery is recommended for patients with native valve endocarditis and moderate or severe heart failure; those patients with staphylococcal NVE, regardless of hemodynamic state, should undergo early valve replacement. Early surgery is recommended for PVE patients with moderate or severe heart failure. We also recommend early valve replacement for early and late staphylococcal PVE.
分析了182例活动性感染性心内膜炎患者在10年期间的手术及非手术治疗结果。心力衰竭、瓣环及心肌脓肿、心脏传导阻滞和冠状动脉栓塞在葡萄球菌性和真菌性心内膜炎中最为常见，是天然瓣膜心内膜炎（NVE）和人工瓣膜心内膜炎（PVE）的主要死亡原因。在NVE中，手术显著提高了中度或重度心力衰竭患者的生存率（P<0.05）以及所有葡萄球菌性心内膜炎患者的生存率（P<0.03）。在PVE中，手术显著影响了中度或重度心力衰竭患者的生存率（P<0.05）以及整个晚期PVE组患者的生存率（P<0.01）。对于患有天然瓣膜心内膜炎和中度或重度心力衰竭的患者，建议早期手术；那些患有葡萄球菌性NVE的患者，无论血流动力学状态如何，均应尽早进行瓣膜置换。对于患有中度或重度心力衰竭的PVE患者，建议早期手术。我们还建议对早期和晚期葡萄球菌性PVE患者尽早进行瓣膜置换。
