Long-Term Outcome for the Surgical Treatment of Infective Endocarditis With a Focus on Intravenous Drug Users
Long-Term Outcome for the Surgical Treatment of Infective Endocarditis With a Focus on Intravenous Drug Users
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DOI：
10.1016/j.athoracsur.2011.08.016
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发表时间：
2012-01-01
影响因子：
4.6
通讯作者：
Aldea, Gabriel S.
中科院分区：
文献类型：
--
作者：
Rabkin, David G.;Mokadam, Nahush A.;Aldea, Gabriel S.
背景。我们回顾了感染性心内膜炎（IE）手术治疗的经验，以评估现代结果并客观地检查我们的机构偏好，包括在静脉注射吸毒者（IVDUs）中使用生物假体，无论年龄如何，以及在脓毒性脑栓塞或活动性感染患者中及时进行手术干预。1999年2月至2010年11月对医疗记录进行了审查。社会保障死亡指数用于确定术后期间任何原因导致的死亡。医院记录用于确定感染并发症、复发性心内膜炎和再手术。结果。64例为IVDUs， 133例为非IVDUs。IVDUs组和非IVDUs组的30天、1年、5年和10年生存率分别为91.2%对93.6%、77.5%对83.0%、46.7%对71.1%、41.1%对52.0%。Cox回归分析发现静脉药物使用是降低生存率的独立危险因素（p = 0.03），尽管95.3%的IVDUs接受生物假体，而73.7%的非IVDUs接受生物假体（p = 0.0002， Fisher精确检验），但静脉药物使用不是再次手术的危险因素（p = 0.95）。术前确认化脓性脑栓塞43例；无围手术期出血事件。活动性感染作为复发性IE和围手术期感染复合终点的独立危险因素接近显著性（优势比为2.8；95%可信区间为0.777至10.9;p = 0.12， Fisher精确检验）。无论年龄大小，生物假体对于接受IE瓣膜置换术的ivdu是合理的。脓毒性脑栓塞的及时手术治疗是合理的；在活动性感染的情况下就不太清楚了。（Ann Thorac surgery 2012;93:51-8） (C) 2012年由胸外科医师协会批准
Background. We reviewed our experience with surgical procedures for infective endocarditis (IE) in order to evaluate modern outcomes and objectively examine our institutional preferences, including the use of bioprostheses in intravenous drug users (IVDUs) regardless of age and prompt surgical intervention in patients with either septic cerebral emboli or active infection.Methods. Review of medical records was conducted from February 1999 to November 2010. The Social Security Death Index was used to determine death from any cause in the postoperative period. Hospital records were used to identify infectious complications, recurrent endocarditis, and reoperation. Results. Sixty-four patients were identified as IVDUs and 133 patients as non-IVDUs. Survival at 30 days, 1 year, 5 years, and 10 years for IVDUs and non-IVDUs was 91.2% versus 93.6%, 77.5% versus 83.0%, 46.7% versus 71.1%, and 41.1% versus 52.0%, respectively. Cox regression analysis identified intravenous drug use as an independent risk factor for diminished survival (p = 0.03), although not for reoperation (p = 0.95) despite 95.3% of IVDUs receiving bioprostheses versus 73.7% of non-IVDUs (p = 0.0002, Fisher's exact test). Forty-three patients were identified as having preoperative septic cerebral emboli; none had a perioperative hemorrhagic event. Active infection approached significance as an independent risk factor for the composite end point of recurrent IE and perioperative infection (odds ratio 2.8; 95% confidence interval, 0.777 to 10.9; p = 0.12, Fisher's exact test).Conclusions. Bioprostheses are reasonable for IVDUs undergoing valve replacement for IE regardless of age. Prompt surgical intervention in the setting of septic cerebral emboli is justified; in the setting of active infection it is less clear. (Ann Thorac Surg 2012;93:51-8) (C) 2012 by The Society of Thoracic Surgeons