Abstract：
BACKGROUND: Treatment for infective endocarditis (IE) is usually medical, with surgery reserved for those failing medical management or developing complications. Currently, 25%-50% of patients undergo surgery for IE with a 70%-80% immediate survival rate. However, there is controversy over the timing of surgery following cerebrovascular events, which occur in 15%-30% of IE patients. This study aimed to investigate whether surgical management is superior to medical management in patients with IE and to determine the optimal timing for surgery following the development of neurological symptoms.
METHODS: Data were collected retrospectively between 2012 and 2018 from 436 patients diagnosed with IE and treated at our tertiary teaching hospital. The authors analysed the type of treatment, the timing of surgery, and the outcomes of these including mortality, IE recurrence, and length of hospital stay.
RESULTS: A total of 421 patients were included in the analysis. More than two-thirds (69.1%) of patients underwent surgical intervention. The survival rate of patients having surgery for IE was 77.2%, compared to 50.7% in patients who did not undergo surgical intervention. 6.8% of patients presented with neurological symptoms; 73.3% of these patients had surgery within 14 days with a 90.9% survival.
CONCLUSIONS: This study finds surgery to be safe with a seemingly higher survival rate compared to medical management alone, although this may be confounded by patients in the medical group being less likely to have surgery. Surgery in patients presenting with neurological symptoms is safe within 2 weeks from presentation with excellent outcomes.
METHODS: Data were collected retrospectively between 2012 and 2018 from 436 patients diagnosed with IE and treated at our tertiary teaching hospital. The authors analysed the type of treatment, the timing of surgery, and the outcomes of these including mortality, IE recurrence, and length of hospital stay.
RESULTS: A total of 421 patients were included in the analysis. More than two-thirds (69.1%) of patients underwent surgical intervention. The survival rate of patients having surgery for IE was 77.2%, compared to 50.7% in patients who did not undergo surgical intervention. 6.8% of patients presented with neurological symptoms; 73.3% of these patients had surgery within 14 days with a 90.9% survival.
CONCLUSIONS: This study finds surgery to be safe with a seemingly higher survival rate compared to medical management alone, although this may be confounded by patients in the medical group being less likely to have surgery. Surgery in patients presenting with neurological symptoms is safe within 2 weeks from presentation with excellent outcomes.
摘要：
背景：感染性心内膜炎（IE）的治疗通常是医学上的，为那些未能通过医疗管理或出现并发症的人保留手术。目前,25％-50％的患者接受IE手术，立即生存率为70％-80％。然而,脑血管事件后的手术时机存在争议，发生在15％-30％的IE患者中。这项研究旨在调查IE患者的手术管理是否优于药物管理，并确定神经系统症状发展后的最佳手术时机。
方法：回顾性收集了2012年至2018年在我们三级教学医院诊断并治疗的436例IE患者的数据。作者分析了治疗的类型，手术的时机,以及这些结果，包括死亡率，IE复发，和住院时间。
结果：共421例患者纳入分析。超过三分之二（69.1％）的患者接受了手术干预。IE手术患者的生存率为77.2%,相比之下，未接受手术干预的患者为50.7%。6.8%的患者出现神经症状；73.3%的患者在14天内接受手术，生存率为90.9%。
结论：这项研究发现，与单纯的医疗管理相比，手术是安全的，存活率似乎更高。尽管这可能会因为医疗组的患者不太可能接受手术而感到困惑。出现神经系统症状的患者在2周内手术是安全的，结果良好。
方法：回顾性收集了2012年至2018年在我们三级教学医院诊断并治疗的436例IE患者的数据。作者分析了治疗的类型，手术的时机,以及这些结果，包括死亡率，IE复发，和住院时间。
结果：共421例患者纳入分析。超过三分之二（69.1％）的患者接受了手术干预。IE手术患者的生存率为77.2%,相比之下，未接受手术干预的患者为50.7%。6.8%的患者出现神经症状；73.3%的患者在14天内接受手术，生存率为90.9%。
结论：这项研究发现，与单纯的医疗管理相比，手术是安全的，存活率似乎更高。尽管这可能会因为医疗组的患者不太可能接受手术而感到困惑。出现神经系统症状的患者在2周内手术是安全的，结果良好。
