开胸心脏直视手术治疗起搏装置相关感染性心内膜炎

目的总结起搏装置相关感染性心内膜炎(CDIE)的外科治疗,为临床治疗此少见难治疾患提供方法。方法回顾性分析近10年收治的CDIE病例,对其发生原因、临床表现、治疗经验进行总结。结果 CDIE 8例,7例经开胸直视手术下取出起搏电极导线,术中均发现起搏电极导线上明确赘生物形成,其中1例合并冠心病同期行冠状动脉旁路移植术,1例合并主动脉瓣赘生物同时行主动脉瓣置换术,2例行三尖瓣成形术。术后临时心外膜起搏保证基本心律,感染完全控制后再次植入起搏装置,所有病例均痊愈出院,随访1~107个月,无一复发。结论开胸心内直视手术取出起搏电极导线及脉冲发生器是治疗CDIE的有效措施。

Open-heart surgery to cure cardiac device related endocarditis

Objective To summarize our experiences of surgical treatment of cardiac device related endocarditis. Method We retrospectively reviewed all cases of cardiac device related endocarditis treated in cardiac surgery department of Peking University people＇s hospital in recent 10 years. Cardiac device related infective endocarditis （CDIE） was defined as the presence of both vegetation on a device lead or valve and clinical or microbiological evidence of CDIE. Result Eight cases with CDIE were treated in our hospital in recent 10 years, 7 CDIE patients were treated by open-heart surgery. The mean age of patients was 52 - 20 years. All patients were treated with complete hardware removal by open-heart surgery and parenteral antibiotics. Besides hardware removel, 1 patient received cornoary artery bypass, 1 patient received aortic valve replacement and 2 patient received tricuspid valve repair. Vegetation were found on the pace lead in all the eases. Temporal pacemaker was used before permanent pacemaker implanted around 29 ＋ 8 days later. All the patients were cured and dismissed with no recurrence during l - 107 months follow-up. Conclusion Open heart surgery combined with antibiotics to cure CDIE is safe and efficient.