Real-world outcomes of surgery for native mitral valve endocarditis
Real-world outcomes of surgery for native mitral valve endocarditis
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DOI：
10.1016/j.jtcvs.2017.07.077
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发表时间：
2017-12-01
影响因子：
6
通讯作者：
Chikwe, Joanna
中科院分区：
文献类型：
--
作者：
Toyoda, Nana;Itagaki, Shinobu;Chikwe, Joanna
背景：共识指南建议对活动性自体二尖瓣感染性心内膜炎的手术治疗采用修复而非置换。然而，当代的做法和长期outcomedataislimited.Methods：多变量考克斯回归被用来比较结果的1970例患者进行孤立的主要二尖瓣修复术（n = 367，19%）或更换（n = 1603，81%）的活动性感染性心内膜炎之间的1998年和2010年在纽约和加州州。主要结局是长期生存。次要结局为复发性心内膜炎和二尖瓣再次手术。中位随访时间为6.6年（范围0-12年），末次随访日期为2015年12月31日。结果：二尖瓣修复率在研究期间从10.7%增加到19.4%（P <0.001）。接受二尖瓣修复术的患者更年轻（55 ± 15岁vs 57 ± 15岁，P = 0.005），充血性心力衰竭的可能性更小（46.3% vs 57.1%，P <0.001），葡萄球菌感染的可能性更小（21.3% vs 32.0%，P <0.001）。二尖瓣修复后的10年生存率为68.8%（95%置信区间[CI]，62.5%-74.3%），置换后为53.5%（95% CI，50.6%-56.4%）（调整后风险比，0.71; 95% CI，0.57-0.88; P = 0.002）。与置换术相比，二尖瓣修复术与12年时心内膜炎复发率较低相关（4.7% [95% CI，2.8%-7.2%] vs 9.5% [95% CI，8.0-11.1%]; P = .03），再次手术率相似（9.1%[95% CI，6.2%-12.8%] vs 8.6% [95% CI，7.1%-10.4%]; P = 0.12）。在活动性心内膜炎中，与瓣膜置换术相比，二尖瓣修复术与更好的生存率和更低的复发感染风险相关，在可行时应作为手术选择。
Background: Consensus guidelines recommend repair over replacement for the surgical treatment of active native mitral valve infective endocarditis. However, contemporary practice and long-term outcome data are limited.Methods: Multivariable Cox regression was used to compare outcomes of 1970 patients undergoing isolated primary mitral valve repair (n = 367, 19%) or replacement (n = 1603, 81%) for active infective endocarditis between 1998 and 2010 in New York and California states. The primary outcome was long-term survival. Secondary outcomes were recurrent endocarditis and mitral reoperation. Median follow-up time was 6.6 years (range 0-12), and last follow-up date was December 31, 2015.Results: Mitral valve repair rates increased from 10.7% to 19.4% over the study period (P < .001). Patients undergoing mitral repair were younger (55 +/- 15 vs 57 +/- 15 years, P = .005), less likely to have congestive heart failure (46.3% vs 57.1%, P < .001), and less likely to have staphylococcal infections (21.3% vs 32.0%, P < .001). Twelve-year survival was 68.8% (95% confidence interval [CI], 62.5%-74.3%) after mitral repair, versus 53.5% (95% CI, 50.6%-56.4%) after replacement (adjusted hazard ratio, 0.71; 95% CI, 0.57-0.88; P = .002). Mitral repair was associated with lower rate of recurrent endocarditis at 12 years than replacement (4.7% [95% CI, 2.8%-7.2%] vs 9.5% [95% CI, 8.0-11.1%]; P = .03), and similar rate of reoperation (9.1%[95% CI, 6.2%-12.8%] vs 8.6% [95% CI, 7.1%-10.4%]; P = .12).Conclusions: In active endocarditis, mitral valve repair is associated with better survival and lower risk of recurrent infection compared with valve replacement and should be the surgery of choice when feasible.