Risk factors associated with surgical treatment of infective endocarditis / 中国胸心血管外科临床杂志

@#Objective    To analyze the risk factors of the death associated with infective endocarditis, and to evaluate the timing of surgical treatment of infective endocarditis. Methods    We retrospectively analyzed the clinical data of 62 patients with infective endocarditis in our hospital between August 2015 and August 2017. There were 43 males and 19 females at age of 19–75 (46.1±16.6) years. The clinical data were divided into a death group and a survival group, a paravalvular leakage group and a no periannular leakage group, an emergency operation group and a non-emergency operation group.The risk factors of infective endocarditis and the choice of operation time were analyzed. Results    Three of the 62 patients (4.8%) died after surgery. Postoperative perivalvular leakage (regurgitation over 2 mm) in 8 patients, accounting for 12.9% of the total. Univariate analysis showed that albumin content, creatinine level, total cardiopulmonary bypass time and ascending aorta occlusion time were significantly associated with early postoperative mortality (P<0.05). The results of logistic analysis showed that age, preoperative albumin level, creatinine level, total cardiopulmonary bypass time, and ascending aorta occlusion time were significantly associated with early postoperative perivascular leakage (P<0.05), and long ascending aorta occlusion time is an independent risk factor for early death (P<0.05). There was no statistical difference in early death and the perivalve leakage between the emergency operation and the non emergency operation. Conclusion    Patients with infective endocarditis should accept early surgical treatment. The choice of surgical approach should be selected according to the actual situation of patients. And we should pay more attention to albumin and creatinine levels in preoperative patients. In the operation, to shorten extracorporeal circulation  time and aortic clamping time can improve the prognosis of patients.

Surgical Outcome and Time of Operation in Ebstein's Anomaly

PURPOSE: Ebstein's anomaly is characterized by ongoing tricuspid regurgitation and right ventricular dysfunction. It is difficult to decide the proper time of surgical correction. The purpose of this study is to evaluate the advantage of early surgical correction of Ebstein's anomaly. METHODS: The clinical records of the sixteen patients, who had undergone tricuspid valvuloplasty with plication of the atrialized RV and followed-up for more than five years, were reviewed. Surgical outcome was analysed as regards year of surgery, age of the patients, echocardiographic grade of severity, Carpentier type, associated cardiac defects, and type of surgery. RESULTS: Of sixteen patients, eight patients underwent tricuspid valve repair before 5 years(8 months to 5 years, mean 2.4 years) of age(group A), and eight patients underwent tricuspid valve repair after 5 years(6 to 23 years, mean 12.9 years) of age(group B). Immediately after the operation, tricuspid incompetence regressed significantly in 5 of group A, and 5 of group B, and reduction in heart size was usual. After short and mid- term follow-up period, four of group A showed mild tricuspid valve regurgitation and right ventricular dilatation and relatively well preserved right ventricular function. However, all of group B showed severe right ventricular dilatation with severe tricuspid regurgitation and both ventricular dysfunction. All of group A were in New York Heart Association class I. However, in group B, only three were in class I. Two of group B died of right heart failure 10 and 16 years after the surgical correction, respectively. The year of surgery, mean follow-up periods, associated cardiac defects, and the preoperative echocardiographic grade of the severity were not different significantly between two groups. But there was a difference between two groups in the mean age of the patients, 12.7+/-5.2 years in group A, 21.7+/-5.5 years in group B. The surgical outcome was not closely related to Carpentier types of Ebstein's anomaly. CONCLUSION: Early repair of tricuspid valve may be advantageous to prevent progressive dilatation of the right side heart and to preserve right ventricular function after surgical correction. But the aging factor was not corrected in our study and it is still necessary to follow-up for a longer period in larger patients group.

Clinical Analysis and Surgical Results of Early, Intermediate, Delayed Operation in 100 Consecutive Aneurysmal Patients

We retrospectively reviewed 100 consecutive patients who were ruptured intracranial aneurysm and were operated on in the department of neurosurgery of Wallace Memorial Baptist Hospital from August 1984 to August 1988. The patients who were operated upon within the first 3 days of their most recent subarachnoid hemorrhage formed the early group, the patients operated upon with 4-7 days formed the intermediate group, after 8 days were considered as the delayed group. Early operation was performed in 30 patients, intermediate operation in 20 patients, and delayed operation in 50 patients. On the base of their clinical outcome, the patients were allocated to one of 4 outcome categories(good, fair, poor, death) at the time of their hospital discharge. The 80% favorable outcome estimated from early operation and 85% from intermediate operation and 90% from delayed operation. The mortality was estimated 13% from early operation and 0% from intermediate operation and 8% from the delayed operation. Each 4 cases of early, intermediate and delayed operation was needed shunt operation for hydrocephalus. In operative result, after 1987 was better than before 1987. In hypertensive patients, there was a tendency to observe poor prognosis than normotensive patients, especially with vasospasm.