Yu V L, Fang G D, Keys T F, Harris A A, Gentry L O, Fuchs P C, Wagener M M, Wong E S
Division of Infectious Diseases, University of Pittsburgh Medical Center, PA 15213.
Ann Thorac Surg. 1994 Oct;58(4):1073-7. doi: 10.1016/0003-4975(94)90458-8.
The objective of our study was to assess the long-term outcome of patients with prosthetic valve endocarditis. We used a multicenter, prospective, observational study design. Six university teaching hospitals with high volume cardiothoracic surgery participated. Seventy-four patients with prosthetic valve endocarditis as defined by explicit, objective criteria were selected for participation. All patients were followed up prospectively for 1 year. Thirty-one percent and 69% had development of endocarditis within 60 days of valve insertion ("early") and after 60 days ("late"), respectively. The most common causes were Staphylococcus epidermidis (40%), Staphylococcus aureus (20%), streptococcal species (18%), and aerobic gram-negative bacilli (11%). Physical signs of endocarditis (new or changing murmur, stigmata, emboli) were seen in 58%. At 6 months and 12 months, mortality was 46% and 47%, respectively. Surgical replacement of the infected valve led to significantly lower mortality (23%) as compared with medical therapy alone (56%), as assessed by both univariate and multivariate analyses (p < 0.05). Improved outcome was seen for the surgical group even when controlling for severity of illness at time of diagnosis. From these findings we conclude that accurate assessment of outcome in prosthetic valve endocarditis requires long-term follow-up of at least 6 months following diagnosis. Surgical therapy warrants greater scrutiny; evaluation in controlled clinical trials is appropriate.
我们研究的目的是评估人工瓣膜心内膜炎患者的长期预后。我们采用了多中心、前瞻性、观察性研究设计。六家进行大量心胸外科手术的大学教学医院参与了研究。按照明确的客观标准，选择了74例人工瓣膜心内膜炎患者参与研究。所有患者均接受了为期1年的前瞻性随访。分别有31%和69%的患者在瓣膜植入后60天内（“早期”）和60天后（“晚期”）发生心内膜炎。最常见的病因是表皮葡萄球菌（40%）、金黄色葡萄球菌（20%）、链球菌属（18%）和需氧革兰氏阴性杆菌（11%）。58%的患者出现了心内膜炎的体征（新出现或变化的杂音、体征、栓子）。在6个月和12个月时，死亡率分别为46%和47%。经单因素和多因素分析评估（p<0.05），与单纯药物治疗（56%）相比，手术更换感染瓣膜可显著降低死亡率（23%）。即使在控制诊断时的疾病严重程度后，手术组的预后仍有所改善。根据这些发现，我们得出结论，人工瓣膜心内膜炎预后的准确评估需要在诊断后至少进行6个月的长期随访。手术治疗值得更深入的研究；在对照临床试验中进行评估是合适的。
