EACTS认可的2023 ESC心内膜炎指南的手术意义:衔接指南和实践

Manuela de la Cuesta, Mateo Marin-Cuartas, Suzanne de Waha, Milan Milojevic, Patrick O Myers, Martin Misfeld, Eduard Quintana, Nikolaos Bonaros, Carlos A Mestres, Torsten Doenst, Alexey Dashkevich, Philipp Kiefer, David Holzhey, Michael A Borger
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摘要

尽管在诊断和治疗方面取得了进展,但感染性心内膜炎(IE)仍然是一种具有高发病率和死亡率的具有挑战性的疾病。由欧洲心胸外科协会批准的2023年欧洲心脏病学会指南进行了重大更新,包括几项关于手术干预的新建议。这篇综述综合了目前关于IE手术治疗的证据,强调了适应症、时机和结果。多学科心内膜炎团队的方法是通过优化诊断和治疗策略来改善患者预后的关键因素。先进的成像技术,如正电子发射断层扫描-计算机断层扫描,提高了诊断的准确性,特别是对人工瓣膜心内膜炎。尽管手术有明显的生存益处,但只有少数符合条件的患者接受手术治疗,这强调了更好的患者选择和及时干预的必要性。此外,有手术指征但不接受手术干预的患者预后更差。更新后的IE指南根据临床情况提供了详细的手术时机建议,包括对中风患者的新考虑。此外,还提出了关于手术后部分口服抗生素治疗的新建议。最后讨论了预防IE复发的重要措施。总之,在多学科合作和增强的诊断工具的指导下,根据明确的建议及时进行手术干预,对于改善IE患者的预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Surgical implications of the 2023 ESC endocarditis guidelines endorsed by EACTS: Bridging guidelines and practice.

Infective endocarditis (IE) remains a challenging condition with high morbidity and mortality despite advances in diagnosis and management. The 2023 European Society of Cardiology guidelines, endorsed by the European Association of Cardio-Thoracic Surgery, introduce significant updates, including several new recommendations with regard to surgical intervention. This review synthesizes current evidence on the surgical management of IE, emphasizing indications, timing, and outcomes. The multidisciplinary Endocarditis Team approach is highlighted as a key factor in improving patient prognosis by optimizing diagnosis and treatment strategies. Advanced imaging techniques, such as positron emission tomography-computed tomography, have enhanced diagnostic accuracy, particularly for prosthetic valve endocarditis. Despite the clear survival benefits associated with surgery, only a minority of eligible patients undergo surgical treatment, underscoring the need for better patient selection and timely intervention. Furthermore, the worse prognosis is found in patients with indications for surgery who do not undergo surgical intervention. The updated IE guidelines provide detailed timing recommendations for surgery based on the clinical scenario, including new considerations for patients with stroke. Additionally, novel recommendations regarding partial oral antibiotic therapy following surgery have been introduced. Finally, important measures for the prevention of IE recurrence are discussed. In conclusion, timely surgical intervention, based on defined recommendations guided by multidisciplinary collaboration and enhanced diagnostic tools, is crucial in improving outcomes for IE patients.

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