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著者: Franck Thuny, Sylvain Beurtheret, Julien Mancini, Vlad Gariboldi, Jean-Paul Casalta, Alberto Riberi, Roch Giorgi, Frédérique Gouriet, Laurence Tafanelli, Jean-François Avierinos, Sébastien Renard, Frédéric Collart, Didier Raoult, Gilbert Habib
雑誌名: Eur Heart J. 2011 Aug;32(16):2027-33. doi: 10.1093/eurheartj/ehp089. Epub 2009 Mar 26.
Abstract/Text
AIMS: To determine whether the timing of surgery could influence mortality and morbidity in adults with complicated infective endocarditis (IE). METHODS AND RESULTS: In 291 consecutive adults with definite IE who underwent surgery during the active phase, we compared those operated on within the first week of antimicrobial therapy (n=95) to those operated on later (n=191). The impact of the timing of surgery on 6-month mortality, relapses, and postoperative valvular dysfunctions (PVD) was analysed using propensity score (PS) analyses. After stratification of the cohort into quintiles based on the PS, ≤1st week surgery was associated with a trend of decrease in 6-month mortality in the quintile of patients with the most likelihood of undergoing this early surgical management [quintile 5: 11% vs. 33%, odds ratio (OR)=0.18, 95% CI (confidence interval) 0.04-0.83, P=0.03]. Patients of this subgroup were younger, were more likely to have Staphylococcus aureus infections, congestive heart failure, and larger vegetations. Besides, ≤1st week surgery was associated with an increased number of relapses or PVD (16% vs. 4%, adjusted OR=2.9, 95% CI 0.99-8.40, P=0.05). CONCLUSION: Surgery performed very early may improve survival in patients with the most severe complicated IE. However, a greater risk of relapses and PVD should be expected when surgery is performed very early.
PMID 19329497 Eur Heart J. 2011 Aug;32(16):2027-33. doi: 10.1093/eurheartj/ehp089. Epub 2009 Mar 26.
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