Infective endocarditis: too ill to be operated?

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.感染性心内膜炎（Infective endocarditis）仍是一类在特定患者群体中伴随高病死率的疾病，患者死亡主要归因于中枢神经系统并发症与充血性心力衰竭。内外科联合治疗可降低复杂病例的早期与远期病死率，尤其适用于合并心力衰竭相关瓣膜功能障碍的患者。此类患者中，心力衰竭是瓣膜置换术的最强适应证。然而，当患者出现神经系统并发症或多器官功能衰竭时，目前尚无外科手术的共识适应证。现有有限数据表明，即便对于需要收入重症监护病房（ICU）的复杂病例，此类手术仍具备可行性，且住院病死率风险处于可接受水平。至关重要的是，需将感染性心内膜炎重症患者纳入多中心研究，采用规范的病情严重程度评分系统，以评估临床与影像学变量对患者预后的影响。在获取此类数据之前，针对个体患者的诊疗决策仍需以临床判断为最佳依据。