背景:右侧感染性心内膜炎(RSIE)是由微生物引起的,发展为心内和心外并发症,院内死亡率高,1年死亡率高。治疗涉及抗生素和手术干预。然而,那些表现为极端的人,例如心力衰竭,或脓毒性休克谁不是常规药物治疗的理想候选人可能受益于微创手术。
目的:这篇综述总结了现有的观察性研究,这些研究报道了在瓣膜或心脏可植入电子设备上进行的感染性心内膜炎导致植被萎缩的微创手术。
方法:进行了有针对性的文献综述,以确定发表在PubMed/MEDLINE上的研究,EMBASE,和Cochrane中央数据库从2015年1月1日至2023年6月5日。根据PRISMA指南,总结了由于RSIE引起的对植被进行微创手术干预的功效和/或有效性。
结果:共纳入11项研究,共208例RSIE患者。有9项研究评估了AngioVac系统的有效性,2项研究评估了半影系统。手术总成功率为87.9%。在8项报告住院指数的研究中,4项研究报告没有死亡,而其他4项研究报告了10例死亡。
结论:这项研究表明,多系统可以为RSIE患者提供微创手术选择,具有很高的手术成功率。然而,关于并发症和死亡率的结果好坏参半.需要进一步的大型队列研究或随机临床试验来评估和/或比较这些系统的疗效和安全性。
BACKGROUND: Right-side infective endocarditis (RSIE) is caused by microorganisms and develops into intracardiac and extracardiac complications with high in-hospital and 1-year mortality. Treatments involve antibiotic and surgical intervention. However, those presenting with extremes e.g. heart failure, or septic shock who are not ideal candidates for conventional medical therapy might benefit from minimally invasive procedures.
OBJECTIVE: This review summarizes existing observational studies that reported minimally invasive procedures to debulk vegetation due to infective endocarditis either on valve or cardiac implantable electronic devices.
METHODS: A targeted literature review was conducted to identify studies published in PubMed/MEDLINE, EMBASE, and Cochrane Central Database from January 1, 2015 to June 5, 2023. The efficacy and/or effectiveness of minimally invasive procedural interventions to debulk vegetation due to RSIE were summarized following PRISMA guidelines.
RESULTS: A total of 11 studies with 208 RSIE patients were included. There were 9 studies that assessed the effectiveness of the AngioVac system and 2 assessed the Penumbra system. Overall procedure success rate was 87.9%. Among 8 studies that reported index hospitalization, 4 studies reported no death, while the other 4 studies reported 10 deaths.
CONCLUSIONS: This study demonstrates that multiple systems can provide minimally invasive procedure options for patients with RSIE with high procedural success. However, there are mixed results regarding complications and mortality rates. Further large cohort studies or randomized clinical trials are warranted to assess and/or compare the efficacy and safety of these systems.