Saffle J R, Gardner P, Schoenbaum S C, Wild W
J Thorac Cardiovasc Surg. 1977 Mar;73(3):416-20.
Treatment of patients with prosthetic valve endocarditis with existing guidelines has failed to reduce the over-all mortality rate to below 50 per cent. However, subgroups with high or lower risk of death can be delineated on the basis of risk factors such as early onset following surgery, high-risk causative organisms, cardiodynamic failure, and septic emboli. High-risk patients comprise more than 70 per cent of those with prosthetic valve endocarditis in recent series. Analysis of previously reported series indicates that the mortality rate for high-risk patients with late onset of prosthetic valve endocarditis treated by valve replacement was less than that of patients receiving only medical therapy. We have treated 6 consecutive patients with prosthetic valve endocarditis (3 early onset, 3 late onset) by valve replacement before completion of a course of antibiotics. All patients survived surgery but one patient died after 4 1/2 months of noninfectious causes. Prompt valve replacement is technically feasible and should become the standard therapy for patients with prosthetic valve endocarditis who do not fall into the lower risk group.
按照现有指南治疗人工瓣膜心内膜炎患者，未能将总体死亡率降至50%以下。然而，根据手术早期发作、高危致病微生物、心脏动力学衰竭和脓毒性栓子等危险因素，可以划分出死亡风险较高或较低的亚组。在最近的系列研究中，高危患者占人工瓣膜心内膜炎患者的70%以上。对先前报道系列的分析表明，接受瓣膜置换术治疗的人工瓣膜心内膜炎迟发高危患者的死亡率低于仅接受药物治疗的患者。在完成抗生素疗程之前，我们对6例连续性人工瓣膜心内膜炎患者（3例早期发作，3例迟发发作）进行了瓣膜置换术治疗。所有患者手术存活，但1例患者在4个半月后死于非感染性原因。及时进行瓣膜置换术在技术上是可行的，对于不属于低风险组的人工瓣膜心内膜炎患者应成为标准治疗方法。
