Dodge A, Hurni M, Ruchat P, Stumpe F, Fischer A P, Van Melle G, Sadeghi H
Department of Cardiovascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Eur J Cardiothorac Surg. 1995;9(6):330-4. doi: 10.1016/s1010-7940(05)80192-7.
Seventy-nine patients (mean age 49 years) underwent valve replacement or repair for active (58.2%) or healed (41.8%) native valve endocarditis between 1976 and 1992. The most common indication for surgery was congestive heart failure (73.4%), followed by multiple systemic emboli (21.5%). Emergency operation was necessary in 27.8% of the cases. Operative mortality was 3.8% (3 patients) and late mortality 15.1% (12 patients). Streptococci were the most common infecting agents (41.8%), followed by Staphylococcus aureus (11.4%). No organisms were isolated in 27 cases (34.2%). Follow-up spanned 379.8 patient-years with a maximum of 15.8 years. Fifteen late valve-related events (periprosthetic leak, recurrent endocarditis, thrombo-embolic events and hemolysis) and 20 other late complications (anticoagulant-related hemorrhage, arrhythmias or congestive heart failure) occurred in 22 patients. The linearized rate for all late complications is 5.8% per patient-year. The influence of eight preoperative variables on overall mortality and late valve-related complications was assessed: age, valve(s) affected, active or healed infection, bacteriology, annular abscess, emergency or elective surgery, preoperative renal function and NYHA class. Only Staphylococcus aureus (P = 0.0012) was a significant predictor of late valve-related complications. Furthermore, no difference in survival or in valve-related complications was found between the active and healed infections.
1976年至1992年间，79例患者（平均年龄49岁）因活动性（58.2%）或已愈合（41.8%）的自体瓣膜心内膜炎接受了瓣膜置换或修复手术。手术最常见的指征是充血性心力衰竭（73.4%），其次是多发性全身栓塞（21.5%）。27.8%的病例需要急诊手术。手术死亡率为3.8%（3例患者），晚期死亡率为15.1%（12例患者）。链球菌是最常见的感染病原体（41.8%），其次是金黄色葡萄球菌（11.4%）。27例（34.2%）未分离出病原体。随访时间跨度为379.8患者年，最长为15.8年。22例患者发生了15例晚期瓣膜相关事件（人工瓣膜周漏、复发性心内膜炎、血栓栓塞事件和溶血）和20例其他晚期并发症（抗凝相关出血、心律失常或充血性心力衰竭）。所有晚期并发症的线性化发生率为每年每患者5.8%。评估了八个术前变量对总体死亡率和晚期瓣膜相关并发症的影响：年龄、受累瓣膜、活动性或已愈合感染、细菌学、瓣周脓肿、急诊或择期手术、术前肾功能和纽约心脏协会（NYHA）分级。只有金黄色葡萄球菌（P = 0.0012）是晚期瓣膜相关并发症的显著预测因素。此外，活动性感染和已愈合感染在生存率或瓣膜相关并发症方面没有差异。
