Outcomes After Surgical Treatment of Native and Prosthetic Valve Infective Endocarditis
Outcomes After Surgical Treatment of Native and Prosthetic Valve Infective Endocarditis
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DOI：
10.1016/j.athoracsur.2011.10.063
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发表时间：
2012-02-01
影响因子：
4.6
通讯作者：
Fraser, Thomas G.
中科院分区：
文献类型：
--
作者：
Manne, Mahesh B.;Shrestha, Nabin K.;Fraser, Thomas G.
背景感染性心内膜炎（IE）药物治疗的死亡和并发症的风险必须与手术治疗的风险相平衡。最近的文献对IE的手术获益得出了相互矛盾的结论。我们回顾了2003年至2007年在克利夫兰诊所接受IE手术治疗的患者，以检查他们的结局。对2003年1月1日至2007年12月31日期间因自体瓣膜和人工瓣膜心内膜炎接受手术的连续患者进行了回顾性分析。对手术结局进行了审查，包括生存率和术后并发症。在住院结束时、30天、1年和末次随访时评估生存率。在研究期间，428例患者接受了IE手术：248例（58%）患有自体瓣膜心内膜炎，180例（42%）患有人工瓣膜心内膜炎。总体而言，90%的患者存活至出院。与自体瓣膜感染患者相比，人工瓣膜感染患者的30天死亡率显著更高（13% vs 5.6%; p < 0.01），但长期生存率无显著差异（35% vs 29%; p = 0.19）。与非金黄色葡萄球菌IE患者相比，金黄色葡萄球菌所致IE患者的住院死亡率（15%对8.4%; p < 0.05）、6个月死亡率（23%对15%; p = 0.05）和1年死亡率（28%对18%; p = 0.02）显著更高。IE的外科治疗与90%的住院生存率相关。30天内，自体瓣膜的结局优于人工瓣膜心内膜炎。长期结果相似。最后，与其他病原体相比，金黄色葡萄球菌与显著更高的死亡率相关。(Ann Thorac Surg 2012;93：489-94）（C）2012年，胸外科医师协会
Background. The risk of death and complications of infective endocarditis (IE) treated medically has to be balanced against those from surgery in constructing a therapeutic approach. Recent literature has drawn conflicting conclusions on the benefit of surgery for IE. We reviewed patients treated surgically for IE at the Cleveland Clinic from 2003 to 2007 to examine their outcomes.Methods. A retrospective review of consecutive patients who underwent surgery for native and prosthetic valve endocarditis between January 1, 2003, and December 31, 2007, was conducted. Surgical outcomes were reviewed to include survival and postoperative complications. Survival was evaluated at end of hospital stay, 30 days, 1 year, and at last follow-up.Results. Four hundred twenty-eight patients underwent surgery for IE during the study period: 248 (58%) had native valve endocarditis and 180 (42%) had prosthetic valve endocarditis. Overall 90% of patients survived to hospital discharge. When compared with patients with native valve infection, patients with prosthetic infection had significantly higher 30-day mortality (13% versus 5.6%; p < 0.01), but long-term survival was not significantly different (35% versus 29%; p = 0.19). Patients with IE caused by Staphylococcus aureus had significantly higher hospital mortality (15% versus 8.4%; p < 0.05), 6-month mortality (23% versus 15%; p = 0.05), and 1-year mortality (28% versus 18%; p = 0.02) compared with non-S aureus IE.Conclusions. Surgical treatment of IE was associated with 90% hospital survival. Outcomes within the 30 days were better for native valve than for prosthetic valve endocarditis. Long-term outcomes were similar. Finally, S aureus was associated with significantly higher mortality compared with other pathogens. (Ann Thorac Surg 2012;93:489-94) (C) 2012 by The Society of Thoracic Surgeons