ZHAO Shuanglei 1 , LIU Zhou 1 , WANG Bin 2 , SUN Zhaoqing 2 , WEN Mingxiu 1 , LI Qianxian 1 , HU Yi 1 , JIANG Wenjian 1 , HAN Jie 1 , WANG Jiangang 1 , GONG Ming 1
  • 1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;
  • 2. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;
GONG Ming, Email: gongming817@hotmail.com
Infective endocarditis; valvuloplasty; valve replacement; affecting factors
10.7507/1007-4848.202309050
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Objective To analyze the clinical efficacy valve surgeries for infective endocarditis and the affecting factors, and compare the early- and long-term postoperative outcomes of different surgery approaches. Methods The patients with infective endocarditis who underwent valve replacement/valvuloplasty in our hospital from 2010 to 2022 were retrospectively collected. The clinical data of the patients were analyzed. Results A total of 343 patients were enrolled, including 197 patients with mechanical valve replacement, 62 patients with bioprosthetic valve replacement, and 84 patients with valvuloplasty. There were 238 males and 105 females with an average age of 44.2±14.8 years. Single-valve endocarditis was present in 200 (58.3%) patients, and multivalve involvement was present in 143 (41.7%) patients. Sixty (17.4%) patients had suffered thrombosis before surgery, including cerebral embolisms in 32 patients. The mean follow-up time was 60.6±43.8 months. Early mortality within one month after the surgery occurred in 17 (5.0%) patients, while later mortality occurred in 19 (5.5%) patients. Eight (2.3%) patients underwent postoperative dialysis, 13 (3.8%) patients suffered postoperative stroke, 6 patients underwent reoperation, and 3 patients suffered recurrence of infective endocarditis. Smoking (P=0.002), preoperative embolisms (P=0.001), duration of surgery (P=0.001), and postoperative dialysis (P=0.001) were risk factors for early mortality, and left ventricular ejection fraction≥60% (P=0.022)was protective factor for early mortality. New York Heart Association classification Ⅲ-Ⅳ (P=0.010) and ≥3 valve procedures (P=0.028) were risk factors for late mortality. The rate of composite endpoint events was significantly lower in the valvuloplasty than that in the valve replacement group. Conclusion For patients with infective endocarditis, smoking and preoperative embolisms are associated with high postoperative mortality, multiple-valve surgery is associated with a poorer prognosis, and valvuloplasty has advantages over valve replacement and should be attempted in the surgical management of patients with infective endocarditis.