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Published on: November 6, 2019
Characteristics and Outcomes of Operated Versus Nonoperated Patients With Infective Endocarditis and Cerebral
Olivia Graveleau1, Johann Cattan1, Gaultier Marnat2
1Valvular Heart Disease Unit, Bordeaux University Hospital-Haut-Lévêque, Pessac, France.
Insights
Cardiac surgery significantly improves survival in infective endocarditis (IE) patients with cerebral complications. Early surgical discussion is recommended for better outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Cerebral complications are frequent in infective endocarditis (IE), negatively impacting patient prognosis.
- Optimal timing for cardiac surgery in IE patients with neurological events is a critical clinical challenge.
Purpose of the Study:
- To characterize IE patients with cerebral complications.
- To compare outcomes between surgically and medically managed IE patients with cerebral complications.
Main Methods:
- Prospective cohort study of 288 IE patients with cerebral complications (2013-2021).
- Classification into operated and non-operated groups.
- Primary outcome: 1-month all-cause mortality; secondary outcomes: 1-year mortality, impact of lesion type and surgical timing.
Main Results:
- One-month mortality was substantially higher in non-operated (27%) versus operated (5.9%) patients (p<0.001).
- Cardiac surgery was an independent predictor of reduced mortality (OR 0.24; p<0.001).
- Cerebral lesion type and surgical timing did not significantly affect prognosis.
Conclusions:
- Cardiac surgery should be strongly considered for IE patients with cerebral complications when indicated.
- Multidisciplinary team management, including neurology, may enhance outcomes for these patients.
Background:
Cerebral complications in patients with infective endocarditis (IE) are common and worsen prognosis. Determining the optimal timing for cardiac surgery in this context remains challenging. In this study we describe the characteristics and outcomes of IE patients with cerebral complications who were managed either surgically or medically.
Methods:
We analyzed all consecutive patients with IE-related cerebral complications enrolled in a prospective cohort study in Aquitaine, France (2013-2021). Patients were classified as operated or nonoperated. The primary outcome was all-cause mortality at 1 month; secondary outcomes included all-cause mortality up to 1 year and the impact of cerebral lesion type and surgical timing.
Results:
Among 1230 IE patients, 288 had cerebral complications (age 65 ± 14 years, 74% male). Ischemic and hemorrhagic cerebral lesions occurred in 76% and 19% of patients, respectively. Severe valvular damages were present in 43% and cardiac surgery was indicated in 86% of cases. One-month mortality was significantly higher among nonoperated vs operated patients (27% vs 5.9%, P < 0.001). Multivariate analysis identified heart failure, coma, and cardiac surgery (odds ratio 0.24, 95% confidence interval 0.10-0.56, P < 0.001) as independent predictors of mortality. Neither the type of cerebral lesion nor surgical timing appeared to affect prognosis.
Conclusions:
When indicated, cardiac surgery should be systematically discussed in IE patients with cerebral complications. Early intervention guided by a multidisciplinary endocarditis team with neurology expertise may improve outcomes.
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