起搏器心内膜炎的外科治疗

目的　介绍 15例起搏器心内膜炎外科治疗的临床经验 ,讨论手术指征和时机。方法　1993年至 2 0 0 1年间 ,我们为 15例起搏器心内膜炎患者 ,施行了体外循环直视下心内起搏电极撤除术。本文对这些病人的临床资料进行回顾性研究。结果　本组病例中 ,有 2例院内死亡 ,术后随访期内 (中间值 =31 3个月 ;区间 ,1 8～ 5 8 7个月 )无远期死亡 ,总死亡率为 13 3%。所有出院病人均无感染复发。大部分病人心功能明显改善 (P <0 0 1)。只有 6例患者术后因持续存在的心律失常需要重新安装起搏器。本组病例中常见的外科手术指征为 :1)附着于起搏电极的大型赘生物 ,2 )顽固感染 ,3)三尖瓣架构损坏 ,4)肺栓塞 ,5 )存在需要外科处理的基础的或并存的心脏病变。结论　根据我们的结果及相关文献报道 ,我们认为对患起搏器心内膜炎的病人 ,应尽早采用外科手术撤除植入的心内起搏器硬件。手术治疗的远期效果是值得信赖的。

Surgical Treatment for Infective Endocarditis Related to Pacemaker Leads

Objective To discuss some surgical indications based on our experience on 15 patients and review of literatures. Methods From 1993 to 2001, 15 patients with infective endocarditis on leads of pacemaker underwent surgical removal of intracardiac pacing system under extracorporeal circulation in our center. Clinical data of these patients were retrospectively analyzed. Results Two in-hospital deaths occurred, but no late death during the follow-up period (Median=31.3 months, ranged from 1.8 to 58.7 months). The overall mortality in this study is 13.3%. All discharged patients are free of the infection, most of them have a significant improvement of cardiac function ( P <0.01). Only 6 patients need postoperative pacemaker re-implantation for persistent cardiac arrhythmia. Five most common surgical indications retrieved from this study are: 1) Large vegetations attached to leads of pacemaker, 2) Persistent infection, 3) Tricuspid architecture alteration, 4) Pulmonary embolism, 5) Underlying or coexisted cardiac disease needing surgical correction.Conclusion With our results and review of literatures, we propose an early surgical removal of implanted permanent intracardiac pacing system for the patients with infective endocarditis on leads of pacemaker. The long-term outcome of this surgical procedure is reliable.