Edwards M B, Ratnatunga C P, Dore C J, Taylor K M
United Kingdom Heart Valve Registry, Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK.
Eur J Cardiothorac Surg. 1998 Aug;14(2):156-64. doi: 10.1016/s1010-7940(98)00148-1.
To assess the 30-day mortality, long-term survival and freedom from reoperation following surgery for prosthetic endocarditis (PVE).
A retrospective analysis of data from the UK Heart Valve Registry of 322 patients who had undergone single mechanical/bioprosthetic valve replacement for PVE between 1 January 1986 and 31 December 1996. The mean age was 54.9 +/- 12.8 years and 213 (66.1%) were males. There were 170 aortic and 152 mitral valve implantations. Eighty-five (26%) of the infected valves were bioprosthetic and 237 (74%) were mechanical. Of the new prostheses implanted 53 (17%) were bioprosthetic and 269 (83%) were mechanical. Of those with infected bioprostheses, 50 (15.2%) had mechanical valves at redo surgery, whilst 219 (68.3%) of infected mechanical prostheses were re-replaced by mechanical prostheses. The follow-up was 98% complete with a total of 1084.9 patient years.
The 30-day mortality was 63 (19.9%; 95%CI 15.9-24.7%). There were 85 late deaths. One, 5 and 10 year survival rates were 67.1% (61.6-72.0%), 55.0% (49.0-60.7%) and 37.6% (27.9-47.2%), respectively. Age was the only significant determinant of 30-day mortality (P = 0.04). Age (P = 0.001) and explanting of infected bioprosthesis and replacement by mechanical valve (P = 0.04) determined long-term survival (P = 0.001). The incidence of re-reoperation was 9.9%. Freedom from reoperation for PVE was 88.4, 87.3 and 87.3% at 1, 5 and 10 years, respectively. Explanting of bioprosthesis and replacement by mechanical valve (P < 0.001) and reoperation within 60 days of native valve replacement (P = 0.02) were determinants of reoperation for PVE. Freedom from death or reoperation was 61.1, 50.6 and 34.2% at 1, 5 and 10 years, respectively. Age (P = 0.003), explanting of bioprosthesis and replacement by mechanical valve (P = 0.002) and the period between prosthetic re-replacement (P = 0.04) determined freedom from death or reoperation.
Operation for PVE carries a high 30-day mortality and reduced long-term survival. There is no evidence that type of prosthesis used for re-reoperation determines survival or freedom from re-reoperation.
评估人工瓣膜心内膜炎（PVE）手术后30天死亡率、长期生存率及再次手术情况。
对英国心脏瓣膜登记处1986年1月1日至1996年12月31日期间322例行单一机械/生物人工瓣膜置换术治疗PVE患者的数据进行回顾性分析。平均年龄为54.9±12.8岁，男性213例（66.1%）。共植入主动脉瓣170个、二尖瓣152个。85个（26%）感染瓣膜为生物瓣，237个（74%）为机械瓣。新植入的人工瓣膜中，53个（17%）为生物瓣，269个（83%）为机械瓣。感染生物瓣患者中，50例（15.2%）在再次手术时植入机械瓣，而219例（68.3%）感染机械瓣患者再次植入机械瓣。随访完整率为98%，总计1084.9患者年。
30天死亡率为63例（19.9%；95%CI 15.9 - 24.7%）。有85例晚期死亡。1年、5年和10年生存率分别为67.1%（61.6 - 72.0%）、55.0%（49.0 - 60.7%）和37.6%（27.9 - 47.2%）。年龄是30天死亡率的唯一显著决定因素（P = 0.04）。年龄（P = 0.001）、感染生物瓣的切除及机械瓣置换（P = 0.04）决定长期生存率（P = 0.001）。再次手术发生率为9.9%。PVE再次手术的无事件生存率在1年、5年和10年分别为88.4%、87.3%和87.3%。生物瓣切除及机械瓣置换（P < 0.001）和自体瓣膜置换后60天内再次手术（P = 0.02）是PVE再次手术的决定因素。1年、5年和10年无死亡或再次手术生存率分别为61.1%、50.6%和34.2%。年龄（P = 0.003）、生物瓣切除及机械瓣置换（P = 0.002）以及人工瓣膜再次置换间隔时间（P = 0.04）决定无死亡或再次手术情况。
PVE手术30天死亡率高且长期生存率降低。没有证据表明再次手术所用人造瓣膜类型决定生存率或再次手术情况。
