What size of vegetation is an indication for surgery in endocarditis?
What size of vegetation is an indication for surgery in endocarditis?
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DOI：
10.1093/icvts/ivs365
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发表时间：
2012-12-01
影响因子：
--
通讯作者：
Adamu, Yahaya B.
中科院分区：
文献类型：
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作者：
Okonta, Kelechi E.;Adamu, Yahaya B.
根据结构化方案编写心脏手术中的最佳证据主题。讨论的问题是心内膜炎的赘生物是否是手术的指征。使用报告的检索共找到102篇论文;确定了16篇论文，为回答该问题提供了最佳证据。列表显示作者、期刊、日期、发表国家、患者组、研究类型、相关结局和结果。使用超声心动图将赘生物大小分为小（< 5 mm）、中（5-9 mm）或大（>= 10 mm），在大多数关于左侧感染性心内膜炎的研究中，赘生物大小>= 10 mm是栓塞事件和死亡率增加的预测因素。对于大的赘生物-通常是由于抗生素在4-8周的治疗中未能减少赘生物的大小-以及并发症，如瓣周脓肿形成，瓣膜破坏和持续发热，需要手术干预。在一项对384例连续感染性心内膜炎患者进行的多中心前瞻性队列研究中，观察到赘生物大小> 10 mm和严重赘生物移动性是新发栓塞事件的预测因素。同样，一项荟萃分析显示，超声心动图检测到左侧感染性心内膜炎患者的赘生物尺寸≥ 10 mm，会显著增加栓塞事件的风险。在另一项211例患者的前瞻性队列研究中，观察到赘生物>= 10 mm时栓塞风险增加。在另一项通过超声心动图研究评估的178例连续感染性心内膜炎患者的类似研究中，发现赘生物> 10 mm时栓塞发生率显著较高（60%，P < 0.001）。当使用植被面积时，> 1.8 cm（2）的植被大小预测并发症的发展。假设植被是一个球体，当使用4 r（2）计算面积时，计算的直径将为8 mm。然而，对于右侧感染性心内膜炎，与赘生物尺寸≤ 10 mm相比，赘生物尺寸> 20 mm与更高的死亡率相关< 20 mm. There is strong evidence to suggest that a vegetation size of >，特别是对于左侧感染性心内膜炎，这是手术的指征。
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the of vegetations in endocarditis is an indication for surgery. Altogether, 102 papers were found using the reported search; 16 papers were identified that provided the best evidence to answer the question. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and results were tabulated. The vegetation size was classified into small (< 5 mm), medium (5-9 mm), or large (>= 10 mm) using echocardiography and a vegetation size of >= 10 mm was a predictor of embolic events and increased mortality in most of the studies with left-sided infective endocarditis. For large vegetations-that commonly resulted from the failure of antibiotics to decrease the vegetation size during 4-8 weeks' therapy-and complications such as perivalvular abscess formation, valvular destruction and persistent pyrexia necessitated surgical intervention. In a multicentre prospective cohort study of 384 consecutive patients with infective endocarditis, it was observed that a vegetation size of > 10 mm and severe vegetation mobility were predictors of new embolic events. Equally, a meta-analysis showed that the echocardiographic detection of a vegetation size of >= 10 mm in patients with left-sided infective endocarditis posed significantly increased risk of embolic events. In another prospective cohort study of 211 patients, it was observed that there was an increased risk of embolization with vegetations of >= 10 mm. In similarly another study of 178 consecutive patients with infective endodarditis assessed by echocardiographic study, it was found out that there was a significantly higher incidence of embolism with a vegetation size > 10 mm (60%, P < 0.001). When using the area of the vegetation, a vegetation size of > 1.8 cm(2) predicted the development of a complication. Assuming that the vegetation was a sphere, the calculated diameter will be 8 mm when using 4r(2) for the area. However, for right-sided infection endocarditis, a vegetation size of > 20 mm was associated with a higher mortality when compared with a vegetation size of < 20 mm. There is strong evidence to suggest that a vegetation size of >= 10 mm especially for left-sided infective endocarditis is an indication for surgery.