在活跃的左侧感染性内心炎中,没有进行手术的手术指示的患者的预后不佳
Mathias Van Hemelrijck1, Juri Sromicki1, Michelle Frank2
1Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.
Frontiers in cardiovascular medicine
|September 11, 2023
概括
需要手术但没有接受手术的左侧传染性内心炎患者年龄较大,病情更严重,生存率明显较低. 这凸显了专门的内心炎团队在处理这些复杂病例方面的关键作用.
科学领域:
- 心脏病学 心脏病学
- 传染性疾病 传染性疾病
- 外科手术的结果
背景情况:
- 左侧传染性内心炎 (IE) 通常需要手术干预.
- 很大一部分患有IE手术指示的患者没有接受手术.
- 这些非手术治疗患者的特征和结果没有得到充分的记录.
研究的目的:
- 描述左侧IE患者的基线特征,这些患者是手术候选人,但仅接受医疗治疗.
- 为了比较外科治疗和医疗治疗的左侧IE患者之间的结果,特别是生存率.
- 为了确定影响不接受手术的决定的因素,符合条件的患者.
主要方法:
- 从2018年1月到2021年12月,对154名感染性内心炎患者的观察队列 (ENVALVE) 的回顾性分析.
- 计算了卡普兰-梅尔生存估计值.
- 两变Cox模型和多变逻辑回归,根据接受手术的倾向进行调整,用于评估生存率和影响治疗决策的因素.
主要成果:
- 116名患者接受了手术,而38名患者仅接受了医疗治疗.
- 非手术候选人年龄较大 (70岁与62岁相比),手术前风险较高 (EuroSCORE II 14%与5.8%相比),并患有更多的并发症.
- 手术患者的一年生存率明显高 (83.7%),与非手术组 (15.3%) 相比.
- 肝硬化和血液透析与接受手术的可能性较低有关.
结论:
- 患有左侧IE的患者,尽管有指示,但没有接受手术,他们更老,患有更多的并发症,风险概况更高.
- 这些患者经历了显著较低的一年生存率.
- 内心炎团队在这个患者亚组的复杂决策过程中发挥着至关重要的作用.
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