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. 2024 Apr 20;19(1):254.
doi: 10.1186/s13019-024-02768-x.

Impact of postoperative cerebral complications in acute infective endocarditis: a retrospective single-center study

Kayo Sugiyama  1 , Hirotaka Watanuki  2 , Masato Tochii  2 , Takayuki Kai  2 , Daisuke Koiwa  2 , Katsuhiko Matsuyama  2
Affiliations

Impact of postoperative cerebral complications in acute infective endocarditis: a retrospective single-center study

Kayo Sugiyama et al. J Cardiothorac Surg. .

Abstract

Background: The treatment of patients with infective endocarditis (IE) who have preoperative cerebral complications remains less understood. Therefore, this study aimed to retrospectively evaluate the clinical outcomes of patients with acute IE based on preoperative intracranial findings.

Methods: Of 32 patients with acute IE treated at our hospital between August 2015 and March 2022, 31 patients of whom preoperative intracranial imaging evaluation was available were included in our analysis and compared with those with and without intracranial findings. We controlled the mean arterial blood pressure and activated clotting time (ACT) to prevent abnormally high perfusion pressures and ACTs during cardiopulmonary bypass (CPB). The preoperative background, and postoperative courses focusing on postoperative brain complications were reviewed.

Results: Among the 31 patients, 20 (65%) had preoperative imaging findings. The group with intracranial findings was significantly older, with more embolisms in other organs, positive intraoperative pathology findings, and longer CPB times. A new cerebral hemorrhage developed postoperatively in one patient without intracranial findings. There were no early deaths; two patients had recurrent infections in each group, and one died because of sepsis in the late phase in the group with intracranial findings.

Conclusions: Positive intracranial findings indicated significantly active infectious conditions preoperatively but did not affect the postoperative course. Patients without preoperative cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of preoperative cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without intracranial findings.

Keywords: Cerebral hemorrhage; Cerebral infarction; Infective endocarditis; Mycotic aneurysm; Subarachnoid hemorrhage.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection
Fig. 2
Fig. 2
(a) Preoperative brain magnetic resonance imaging of a patient showing almost normal. (b) Postoperative brain computed tomography image of a patient showing broad cerebral hemorrhage. (c) Preoperative brain magnetic resonance angiography of a patient showing no mycotic aneurysm
Fig. 3
Fig. 3
(a) Freedom from MACCE in patients with and without cerebral complications. (b) Freedom from events related to IE in patients with and without cerebral complications
See this image and copyright information in PMC

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References

    1. Lalani T, Cabell CH, Benjamin DK, Lasca O, Naber C, Fowler VG, Jr, et al. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation. 2010;121:1005–13. doi: 10.1161/CIRCULATIONAHA.109.864488. - DOI - PMC - PubMed
    1. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, Kotilainen P. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med. 2000;160:2781–7. doi: 10.1001/archinte.160.18.2781. - DOI - PubMed
    1. García-Cabrera E, Fernández-Hidalgo N, Almirante B, Ivanova-Georgieva R, Noureddine M, Plata A, et al. Neurological complications of infective endocarditis: risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation. 2013;127:2272–84. doi: 10.1161/CIRCULATIONAHA.112.000813. - DOI - PubMed
    1. Yoshioka D, Toda K, Sakaguchi T, Okazaki S, Yamauchi T, Miyagawa S, et al. Valve surgery in active endocarditis patients complicated by intracranial haemorrhage: the influence of the timing of surgery on neurological. Eur J Cardiothorac Surg. 2014;45:1082–8. doi: 10.1093/ejcts/ezt547. - DOI - PubMed
    1. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Jr, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the councils on Clinical Cardiology, Stroke, and cardiovascular surgery and anesthesia. Circulation. 2005;111:e394–434. doi: 10.1161/CIRCULATIONAHA.105.165564. - DOI - PubMed

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