高龄感染性心内膜炎患者的手术疗效分析

 目的  总结高龄感染性心内膜炎患者的临床特点及手术疗效。  方法  2003年1月至2012年12月,24例高龄(≥70岁)感染性心内膜炎患者在复旦大学附属中山医院行手术治疗,年龄70～82(73.0±3.2)岁,男性20例,女性4例。全组共行主动脉瓣置换术8例,二尖瓣置换术5例,双瓣置换术7例,二尖瓣成形术2例,起搏导线拆除术2例。同期行冠状动脉搭桥术7例,房颤消融术1例。  结果  术后早期死亡2例(8.3%),1例死于术后低心排,1例死于术后呼吸功能衰竭。其余22例均治愈出院。随访20例(90.9%),随访时间21～137(76.6±35.6)月,1例双瓣置换术后47个月死于非心源性疾病,其余随访患者均恢复良好。  结论  手术治疗感染性心内膜炎患者是风险可接受的,术后早期和晚期疗效满意。

Surgical efficacy for infective endocarditis in elderly patients

Objective  To summarize the clinical characteristics and surgical efficacy of infective endocarditis in elderly patients.  Methods  Between January 2003 and December 2012, 24 patients who were older than 70 years underwent surgical treatment in our hospital were included in this study. Among them, 20 patients were male and the median age was 73.0±3.2 years, range 70-82 years.The surgical procedures included aortic valve replacement in 8 patients, mitral valve replacement in 5 patients, double valve replacement in 7 patients, mitral valve repair in 2 patients and removing of pacing wires in 2 patients. Concomitant procedures included coronary artery bypass grafting in 7 patients and radiofrequency ablation of atrial fibrillation in 1 patient.  Results  Two patients died in hospital and the reasons included respiration failure and low cardiac output, respectively. Twenty patients were followed up for 21-137 (76.6±35.6) months. One patient died for non-cardiac disease after 47 months and other patients were well during the period of follow-up.  Conclusions  Surgical management for infective endocarditis in elder patients is a safe alternative with acceptable risk of death and the early and late results are satisfactory.