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Importancia relativa del tiempo frente al tamaño del accidente cerebrovascular preoperatorio para la operación de la
Brittany A Zwischenberger1, Akosua Odei1, Christopher Jensen1
1Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham NC, USA.
The Annals of thoracic surgery
|August 29, 2025
Resumen
Para la cirugía de endocarditis infecciosa, los grandes accidentes cerebrovasculares preoperatorios aumentan el riesgo de accidente cerebrovascular postoperatorio, independientemente del momento de la cirugía. Se recomienda la intervención temprana en pacientes con endocarditis infecciosa del lado izquierdo y pequeños accidentes cerebrovasculares preoperatorios.
Área de la Ciencia:
- Cardiología
- Neurocirugía
- Enfermedades infecciosas
Sus antecedentes:
- No está claro cuál es el momento óptimo para la cirugía en endocarditis infecciosa (IE) con accidente cerebrovascular preoperatorio.
- La IE afecta las válvulas del corazón, y el accidente cerebrovascular es una complicación potencial.
Objetivo del estudio:
- Determinar la asociación entre las características preoperatorias del accidente cerebrovascular y el momento de la operación con el accidente cerebrovascular postoperatorio en pacientes con IE.
- Para guiar la toma de decisiones quirúrgicas en pacientes con IE con antecedentes de accidente cerebrovascular.
Principales métodos:
- Revisión retrospectiva de pacientes adultos sometidos a una operación de válvula para la IE aguda (1991-2023).
- Definición del accidente cerebrovascular preoperatorio de gran tamaño: volumen del accidente cerebrovascular >= 20 cm3 mediante resonancia magnética.
- Análisis de regresión logística multivariable para identificar los factores de riesgo de accidente cerebrovascular postoperatorio.
Principales resultados:
- El 21% de los pacientes con IE tuvo un accidente cerebrovascular preoperatorio; la mayoría fueron pequeños e isquémicos.
- El accidente cerebrovascular postoperatorio ocurrió en el 4,3% de todos los pacientes y fue más probable en aquellos con accidente cerebrovascular preoperatorio (6,9% frente a 3,7%).
- El accidente cerebrovascular importante preoperatorio aumentó significativamente el riesgo de accidente cerebrovascular postoperatorio (22% frente al 4%), independientemente del tiempo transcurrido entre el accidente cerebrovascular y la operación.
Conclusiones:
- El tamaño del accidente cerebrovascular, no el momento de la operación, está significativamente asociado con el accidente cerebrovascular postoperatorio en IE.
- Se debe considerar la intervención temprana en pacientes con IE del lado izquierdo con pequeños accidentes cerebrovasculares preoperatorios.
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