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Infective endocarditis: too ill to be operated?

机译:感染性心内膜炎:病得不能手术?

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Infective endocarditis remains a disease associated with high mortality in certain groups of patients, with death resulting primarily from central nervous system complications and congestive heart failure. Combined medical and surgical therapy reduces both early and late mortality in complicated cases, especially in patients with valvular dysfunction related to heart failure. In these patients, heart failure is the strongest indication for valve replacement. There are no consensus indications for surgery, however, in the presence of neurological complications or multiple organ failure. Limited data suggest that such surgery is feasible, even in complicated cases necessitating admission to the intensive care unit, and carries an acceptable risk for in-hospital mortality. It is important that critically ill patients with infective endocarditis are enrolled into multicenter studies, using adequate severity scoring systems to assess the impact of clinical and imaging variables on patients' outcome. Until such data are obtained, clinical judgement is still the best tool in decision-making regarding the individual patient.Keywords: decision-making, infective endocarditis, neurological complications, valve replacement
机译:感染性心内膜炎仍然是某些患者高死亡率的疾病,其死亡主要是由中枢神经系统并发症和充血性心力衰竭引起的。在复杂情况下,尤其是患有与心力衰竭相关的瓣膜功能不全的患者,药物和外科手术疗法相结合可降低早期和晚期死亡率。在这些患者中,心力衰竭是瓣膜置换的最强适应症。然而,在存在神经系统并发症或多器官功能衰竭的情况下,尚无手术共识。有限的数据表明,即使在需要入院重症监护室的复杂病例中,这种手术也是可行的,并且具有可接受的院内死亡风险。重要的是,应使用适当的严重性评分系统评估临床和影像学变量对患者预后的影响,将重症感染性心内膜炎患者纳入多中心研究。在获得此类数据之前,临床判断仍然是针对每个患者进行决策的最佳工具。关键词:决策,感染性心内膜炎,神经系统并发症,瓣膜置换

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