背景和目的:尚未彻底研究天然二尖瓣心内膜炎手术后长期结局的决定因素。这项研究的目的是评估解剖学,疾病,以及长期死亡率和需要再干预的手术风险因素,因活动性心内膜炎而接受二尖瓣手术的患者。材料和方法:在三个学术中心接受活动性天然二尖瓣心内膜炎手术的患者,在2000年至2022年之间,进行了分析。主要结果是长期生存。次要结果是无二尖瓣再手术。用Kaplan-Meier方法构建生存曲线。多变量Cox回归用于识别人口统计,解剖学,疾病,以及与晚期死亡率和再次手术相关的手术因素。结果:分析了335例连续活动性二尖瓣心内膜炎患者。200名患者(70.5%)的感染仅限于瓣膜瓣尖,而89名(25.6%)的侵袭性疾病扩展到瓣环和周围组织。52例患者在诊断时发生术前神经系统事件。链球菌是最常见的致病菌,其次是金黄色葡萄球菌,凝固酶阴性葡萄球菌,和肠球菌.108例(32.2%)患者进行了瓣膜修复。5年和10年生存率分别为70.1%和59.2%,分别。葡萄球菌是晚期死亡率的独立预测因子,随着年龄的增长,慢性阻塞性肺疾病,和以前的心脏手术。与没有金黄色葡萄球菌的患者相比,金黄色葡萄球菌患者的生存率大大降低(logrankp<0.001)。手术类型(修复与替代)并未成为晚期死亡率和再次手术的危险因素。随访期间有17例患者接受了二尖瓣再手术。5年和10年的再手术自由度分别为94.7%和91.8%,分别。结论:活动性二尖瓣心内膜炎仍然是一种危及生命的疾病,生存受损。虽然病变特征影响手术决策和术中管理,它们对长期生存和免于再干预的影响似乎受到病原体感染和患者合并症等其他因素的影响.
Background and Objectives: Determinants of long-term outcomes after surgery for native mitral valve
endocarditis have not been thoroughly investigated. The aim of this study was to assess anatomical, disease, and surgical risk factors for long-term mortality and need of reintervention, in patients undergoing mitral valve surgery for active
endocarditis. Materials and Methods: Patients who underwent surgery for active native mitral valve
endocarditis at three academic centres, between 2000 and 2022, were analysed. The primary outcome was long-term survival. The secondary outcome was the freedom from mitral reoperation. Survival curves were constructed with Kaplan-Meier methodology. Multivariable Cox regression was used to identify demographic, anatomical, disease, and surgical factors associated with late mortality and reoperation. Results: 335 consecutive patients with active mitral
endocarditis were analysed. Two hundred and one patients (70.5%) had infection confined to the valve cusp whereas 89 (25.6%) had invasive disease extended to the annulus and surrounding tissues. Preoperative neurological events occurred at the diagnosis in 52 cases. Streptococci were the most common causative organisms followed by Staphylococcus aureus, Coagulase-negative Staphylococcus, and Enterococcus. Valve repair was performed in 108 patients (32.2%). Survival at 5 and 10 years was 70.1% and 59.2%, respectively. Staphylococcus emerged as an independent predictor of late mortality, along with age, chronic obstructive pulmonary disease, and previous cardiac surgery. Survival was considerably reduced in patients with S. aureus compared with those without (log rank p < 0.001). The type of surgery (repair vs. replacement) did not emerge as a risk factor for late mortality and reoperation. Seventeen patients underwent mitral reoperation during the follow-up. The 5- and 10-year freedom from reoperation was 94.7% and 91.8%, respectively. Conclusions: Active mitral valve
endocarditis remains a life-threatening disease with impaired survival. While lesion characteristics influenced surgical decision-making and intraoperative management, their impact on long-term survival and freedom from reintervention appears to be moderated by other factors such as infecting pathogens and patient comorbidities.