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[Surgical management of infective endocarditis with cerebrovascular complications]

Changtian Wang1, Biao Xu1, Lei Zhang1

  • 1Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.

Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]
|September 12, 2015
PubMed

Insights

Surgical treatment of active infective endocarditis (IE) in patients with recent cerebrovascular events can improve outcomes. Comprehensive assessment of surgical indications and risks is crucial before intervention to prevent further neurologic deterioration.

Area of Science:

  • Cardiology
  • Neurosurgery
  • Infectious Diseases

Background:

  • Active infective endocarditis (IE) poses significant risks, especially in patients with recent cerebrovascular events.
  • Cerebrovascular complications in IE patients present unique challenges for surgical management.
  • Optimal timing and indications for surgery in this high-risk population remain debated.

Purpose of the Study:

  • To evaluate the outcomes of surgical treatment for active IE in patients who have experienced recent cerebrovascular events.
  • To determine the optimal indications and timing for surgical intervention in this patient cohort.

Main Methods:

  • Retrospective analysis of clinical data from 26 patients with IE and pre-operative cerebrovascular complications (December 2007-December 2013).
  • Included patients with cerebral infarction or hemorrhage, undergoing various valve surgeries (mechanical/bioprosthetic replacement, mitral valve repair).
  • Data analyzed included interval from cerebrovascular event to surgery, vegetation characteristics, and post-operative outcomes.

Main Results:

  • The mean interval between cerebrovascular event and surgery was 20±4 days, with most patients operated on between 14-21 days.
  • Intraoperative findings revealed 33 vegetations, with a mean size of 10±4 mm, predominantly on the mitral valve.
  • In-hospital mortality was 7.7% (2 patients), with one late relapse. The remaining patients achieved New York Heart Association class I-II functional status post-operatively.

Conclusions:

  • Surgical intervention can be effective in improving outcomes for IE patients with cerebrovascular complications.
  • Careful pre-operative assessment of surgical indications and potential risks of neurologic deterioration is essential.
  • Individualized treatment strategies considering both cardiac and neurologic status are recommended.
Abstract

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