心脏瓣膜术后感染性心内膜炎再次手术后临床预后的分析

The clinical reoperation prognosis of artifitial valve infective endocarditis

目的:分析心脏瓣膜置换或成形术后感染性心内膜炎再次进行外科手术后的近期及远期预后情况。方法:分析了2007年01月至2017年12月,在安贞医院就诊的心脏瓣膜术后感染性心内膜炎患者,以单纯感染性心内膜手术患者为对照组,并根据年龄、性别按1∶1的比例配对,每组67例。结果:与单纯感染性心内膜炎的患者相比,瓣膜术后感染性心内膜炎患者术前LVEF和心功能分级均明显较低[(61.2±7.5)%vs.(56.9±10.1)%,P=0.003;(2.9±0.9)vs.(2.4±0.7), P=0.006],其它基线资料无明显差异。瓣膜术后感染性心内膜炎患者再次手术后住院时间[12.0(19.5,20.5)vs. 7.5 (6.0,10.8)d,P=0.03]、体外循环时间[145.0 (118.5,203.0)vs.100.0 (81.0,132.0)min,P<0.001]均明显延长。经过平均(87.9±42.5)个月的随访,心脏瓣膜术后感染性心内膜炎患者总体不良心血管事件(26.9%vs.11.9%,P=0.03)发生率和远期死亡率(19.4%vs.7.5%,P=0.04)均明显增加,但术后30 d内病死率、再次手术率以及心律失常等不良事件的发生,两组并没有明显区别。Kaplan-Meier生存分析结果显示,心脏瓣膜术后感染性心内膜炎再手术后10年预期生存率约为59.4%,而单纯感染性心内膜炎进行手术后的10年生存率约为86.4%。结论:与单纯感染性心内膜炎患者相比,两组患者早期死亡率没有区别,但心脏瓣膜术后感染性心内膜炎患者远期死亡率明显较高。

Objective: The short-term and long-term prognosis of infective endocarditis after cardiac valve replacement or plasty is not yet clear. Therefore, this study aims to explore the short and long term clinical prognosis of these patients. Methods: From January 2007 to December 2017, we analyzed the patients with infective endocarditis after cardiac valve surgery in Anzhen Hospital. The control group was defined as patients with infective endocarditis only. The patients were matched according to age and sex in a ratio of 1∶1, 67 cases in each group. Results: Compared with patients with infective endocarditis alone, the preoperative left ventricular ejection fraction and cardiac function grading of patients with infective endocarditis after cardiac valve surgery were significantly lower [(61.2± 7.5)% vs.(56.9±10.1)%, P=0.003;(2.9±0.9) vs.(2.4±0.7), P=0.006], and there was no significant difference in other baseline data. The hospital stay after surgery and cardiopulmonary bypass time of patients with infective endocarditis after cardiac valve surgery were significantly prolonged[ 12.0(19.5,20.5)vs. 7.5(6.0,10.8)d, P=0.03;145.0(118.5,203.0) vs. 100.0(81.0,132.0)min, P<0.001]. There was no significant difference in the remaining perioperative data between the two groups. After an average follow-up of(87.9+42.5) months, the overall incidence of adverse cardiovascular events(26.9% vs. 11.9%, P=0.03) and long-term mortality(19.4% vs. 7.5%, P=0.04) in patients with infective endocarditis after cardiac valve surgery were significantly increased, but the mortality within 30 days after operation, reoperation rate and arrhythmia were no significant difference between the two groups. Kaplan-Meier survival analysis showed that the 10-year survival rate of infective endocarditis after cardiac valve surgery was about 59.4%, while the infective endocarditis alone was about 86.4%. Conclusions: Compared with patients with infective endocarditis alone, there is no difference in early mortality between the two groups, but the long-term mortality of patients with infective endocarditis after cardiac valve surgery is significantly higher.