Objective To study the timing of cardiac valve replacement(CVR)in patients with acute infective endocarditis(AIE)under cardiopulmonary bypass(CPB)based on coagulation and fibrinolysis system.Methods Ninety-eight patients with AIE who were admitted in Handan Central Hospital from January 2020 to January 2022 conducted on this study.All patients were divided into two groups based upon the timing of CVR after diagnosis.49cases underwent CVR under CPB within one week as the early group;another 49 cases underwent CVR under CPB over one week as the delayed group.Operative treatment,transesophageal echocardiography(TEE)related indexes[central venous pressure(CVP),cardiac discharge index(CI),left ventricular ejection fraction(LVEF)],thrombin fibrinolysis system indexes[PT),antithrombinⅢ(ATⅢ),fibrin(FIB),partial thrombin time(APTT)were observed and compared between the two groups.The following items were also recorded for all patients including thrombin time(TT),D-dimer(D-D)],inflammatory cytokines[interleukin-18,IL-1β],peripheral blood monocyte pyrogen related proteins[Nod-like receptor protein 3(NLRP3),cysteine aspartase 1(Caspase-1),dermatin D(GSDMD)],postoperative complications during hospitalization incidence and mortality one year after operation.Results CVP,FIB and D-D were decreased;CI and LVEF were increased in both groups(t=4.443,P<0.05)at 3 and 7 days after surgery.FIB and D-D ofthe early group were lower than those of the delayed group(P<0.05).The levels of IL-18 and IL-1β in the two groups were higher at 3 days than before,and decreased at 7 days as compared with 3 days after surgery(P<0.05).The expressions of NLRP3,Caspase-1 and GSDMD in two groups were increased by day3 and decreased at 7 day;but no significantly difference in those as compared with before surgery(P>0.05).The hospital stay of the early group was shorter than that of the delayed group(P<0.05).The 1-year postoperative mortality in the early group was lower than that in the delayed group(P<0.05).Conclusion CVR under CPB in patients with AIE can reduce the postoperative inflammatory response and promote the recovery of postoperative cardiac function and coagulation and fibrinolytic systems.However,early surgery has better results and can reduce the incidence of postoperative complications and mortality in our study.
Active infective endocarditisThrombin fibrinolysis systemCardiopulmonary bypassCardiac valve replacement surgeryInflammatory response
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