Kuyvenhoven J P, van Rijk-Zwikker G L, Hermans J, Thompson J, Huysmans H A
Department of Infectious Diseases, University Hospital, Leiden, The Netherlands.
Eur J Cardiothorac Surg. 1994;8(8):420-4. doi: 10.1016/1010-7940(94)90083-3.
Between 1975 and 1990, 70 episodes of prosthetic valve endocarditis (PVE) were diagnosed in 65 patients at Leiden University Hospital. The overall mortality rate was 27%. Antecedent endocarditis attributable to the same micro-organism (mortality 63%, P = 0.02) and Staphylococcus aureus as the causative micro-organism (mortality 100%, P = 0.001) were significant predictors for mortality. Sex, type and position of the valve and therapy had no significant influence on the mortality. All patients infected with S. aureus died, irrespective of whether they received medical treatment alone or in combination with surgery. None of the patients with streption, endocarditis had abscesses at reoperation; the mortality rate for this group was 14%. Abscess formation, especially in aortic valves, was the most important finding at reoperation and corresponded with a mortality rate of 55%. Ring abscesses occurred equally in patients with mechanical and bioprosthetic valves. Seven of the 15 patients (47%) with significant prosthetic valve dehiscence died. In patients with mitral valve endocarditis, localized dehiscence of the valve was observed. In conclusion a previous endocarditis attributable to the same micro-organism and the causative micro-organism (S. aureus) were important risk factors for mortality due to PVE.
1975年至1990年间，莱顿大学医院65例患者被诊断出70例人工瓣膜心内膜炎（PVE）。总死亡率为27%。由相同微生物引起的先前心内膜炎（死亡率63%，P = 0.02）以及作为致病微生物的金黄色葡萄球菌（死亡率100%，P = 0.001）是死亡率的重要预测因素。性别、瓣膜类型和位置以及治疗对死亡率没有显著影响。所有感染金黄色葡萄球菌的患者均死亡，无论他们单独接受药物治疗还是药物与手术联合治疗。链球菌性心内膜炎患者再次手术时均无脓肿形成；该组死亡率为14%。脓肿形成，尤其是主动脉瓣脓肿形成，是再次手术时最重要的发现，死亡率为55%。机械瓣膜和生物瓣膜患者发生瓣周脓肿的情况相同。15例人工瓣膜显著裂开的患者中有7例（47%）死亡。二尖瓣心内膜炎患者可见瓣膜局部裂开。总之，由相同微生物引起的先前心内膜炎以及致病微生物（金黄色葡萄球菌）是人工瓣膜心内膜炎导致死亡的重要危险因素。
