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Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Intracranial mycotic aneurysm is associated with cerebral bleeding post-valve surgery for infective endocarditis
Yuta Kume1, Tomoyuki Fujita1, Satsuki Fukushima1
1Department of Cardiac Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Insights
Preoperative cerebral hemorrhage (CH) does not increase risks for valve surgery in infective endocarditis patients. However, mycotic aneurysms significantly increase the risk of postoperative CH, impacting long-term outcomes.
Area of Science:
- Cardiology
- Neurosurgery
- Infectious Diseases
Background:
- Preoperative cerebral hemorrhage (CH) is a known risk factor for in-hospital cerebrovascular complications after valve surgery for acute infective endocarditis.
- Long-term risk factors for cerebrovascular complications in these patients remain poorly understood.
Purpose of the Study:
- To investigate the risk factors associated with both in-hospital and long-term outcomes in patients undergoing valve surgery for acute infective endocarditis.
- To evaluate the impact of preoperative cerebral hemorrhage (CH) on these outcomes.
Main Methods:
- A retrospective review of 148 patients who underwent valve surgery for active infective endocarditis between 2000 and 2016.
- Patients were categorized into two groups: those with preoperative CH (n=25) and those without (n=123).
- The study also considered patients with preoperative mycotic aneurysm (MA) (n=14).
Main Results:
- Thirty-day mortality was 5% with no significant difference between groups.
- Five-year survival rates were 92% for the CH group and 77% for the non-CH group.
- Preoperative mycotic aneurysm (MA) was identified as the sole independent risk factor for postoperative CH (P=0.002), with 5-year freedom from CH being 71% in MA patients versus 99% in non-MA patients.
Conclusions:
- Valve surgery for acute infective endocarditis is a safe procedure, even in patients with preoperative CH, irrespective of surgical timing.
- The presence of intracranial mycotic aneurysms is a significant risk factor for both in-hospital and long-term postoperative cerebral hemorrhage.
Objectives:
The presence of cerebral haemorrhage (CH) preoperatively is a risk factor of in-hospital cerebrovascular complications post-valve surgery for acute infective endocarditis. However, factors related to cerebrovascular complications in the long term are poorly understood. We reviewed a series of these patients to investigate risk factors of in-hospital and long-term outcomes.
Methods:
An institutional series of 148 patients who underwent valve surgery for active infective endocarditis between 2000 and 2016 were enrolled. Patients were divided into 2 groups based on the presence of preoperative CH:CH group (n = 25) and non-CH group (n = 123). Of them, 14 (10%) patients were preoperatively diagnosed with mycotic aneurysm (MA).
Results:
The 30-day mortality was 5% with no difference between the 2 groups. The 5-year survival rate was 92% in the CH group and 77% in the non-CH group. Freedom from CH at 5 years was 92% in the CH group and 97% in the non-CH group. There was no difference in the postoperative haemorrhage rate between patients who had surgery within 14 days from the onset of CH and those who had surgery after 14 days. Freedom from CH at 5 years was 99% in patients without MA and 71% in those with MA. The presence of MA preoperatively was the only independent risk factor of postoperative CH (P = 0.002).
Conclusions:
Valve surgery for acute infective endocarditis is safe, even in patients with CH preoperatively, regardless of the timing of surgery. Patients with intracranial MA are associated with postoperative CH in the hospital and long term.
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