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Surgical management of infective endocarditis associated with cerebral complications
Open accessAbstract
To establish guidelines for the surgical treatment of patients with infective endocarditis who have cerebrovascular complications, we conducted a detailed retrospective study of 181 of 244 patients with cerebral complications among 2523 surgical cases of infective endocarditis of the Japanese Association of Thoracic Surgery. The results showed that 9.7% of all patients with infective endocarditis had associated cerebral complications: 108 (44.3%) had active native valve endocarditis, 96 (39.3%) had healed native valve endocarditis, and 40 (16.4%) had prosthetic valve endocarditis. The hospital mortality of the patients with cerebral complications was 11.0% in the group as a whole: 13.9% in active native valve endocarditis, 3.1% in healed native valve endocarditis, and 37.5% in prosthetic valve endocarditis. Diseased valves included the following aortic valve in 55.5%, mitral valve 49.8%, tricuspid valve in 1.3%, and pulmonary valve in 1.3%. In 181 patients with cerebral complications, organisms were detected as follows: gram-positive cocci in 133 (73.5% [Streptococcus in 85, Staphylococcus in 32]), gram-negative in 18 (9.9%), fungus in 11 (6.1%), and unknown in 64.6%, cerebral bleeding in 31.5%, cerebral abscess in 2.8%, and meningitis in 1.1%. Hospital mortality rate and an exacerbation rate of cerebral complications, including related death, according to the interval from onset of cerebral infarction to cardiac surgery, were as follows: 66.3% and 45.5% within 24 hours, 31.3% and 43.8% between 2 and 7 days, 16.7% and 16.7% between 8 and 14 days, 10.0% and 10.0% between 15 and 21 days, 26.3% and 10.5% between 22 and 28 days, and 7.0% and 2.3% over 4 weeks later, respectively. A significant correlation existed between the interval and the exacerbation of cerebral complications (tied p = 0.008). Preoperative risk factors affecting exacerbation of cerebral complications were as follows: (1) severity of cerebral complications (p = 0.006), (2) intervals (p = 0.012), and (3) uncontrolled congestive heart failure as indications for cardiac surgery (p = 0.014). One patient underwent a cardiac operation within 24 hours of the onset of cerebral hemorrhage and died of cerebral damage. No exacerbations occurred in 10 patients who underwent their operation between 2 and 28 days. Nevertheless, exacerbations occurred in 19.0% of patients whose operation was done more than 4 weeks later. These data suggest that cardiac operations can be done safely 4 weeks after cerebral infarction, and if the delay is more than 2 weeks, the exacerbation rate will be around 10%. The risk of progression of cerebral damage is still significant 15 days and even 4 weeks after cerebral hemorrhage.
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“However, these initial studies included a limited number of patients, and risk adjustments were not performed.”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [267]
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“The high rates of postoperative morbidity and mortality seen in earlier studies [265][266][267] have resulted in a reluctance to refer patients with IE and acute stroke for immediate valve surgery.”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [267]
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“The largest early series of operated patients with cerebral complications included 181 patients.267 Hospital mortality rates as a function of the interval between evidence of cerebral infarction to cardiac surgery were 66.3% when surgery was performed within 24 hours of stroke and gradually decreased every week to 7.0% with surgery >4 weeks after stroke.”
From Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association (2015) · cites this paper as [267]
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Metadata
- Authors
- Eishi, K., Kawazoe, K., Kuriyama, Y., Kitoh, Y., Kawashima, Y., & Omae, T.
- Affiliations
- National Cerebral and Cardiovascular Center (JP)
- ORCID
- Eishi, Kiyoyuki
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 1995-12
- Volume
- 110
- Issue
- 6
- Pages
- 1745-1755
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2090277811
- Cited by
- 299
- References
- 29
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 9 · 2023: 5 · 2022: 6 · 2021: 6 · 2020: 14 · 2019: 9 · 2018: 8 · 2017: 13 · 2016: 22 · 2015: 13 · 2014: 13 · 2013: 21 · 2012: 10
- FWCI
- 3.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Keywords
- infective endocarditis, cerebral complications, cardiac surgery, native valve endocarditis, prosthetic valve endocarditis, in-hospital mortality, cerebral infarction, cerebral hemorrhage, time to surgery, Streptococcus, Staphylococcus, fungal endocarditis, aortic valve, mitral valve, risk factors for poor outcome
- MeSH terms
- Adult, Cerebrovascular Disorders, Endocarditis, Endocarditis, Bacterial, Female, Humans, Japan, Male, Retrospective Studies, Risk Factors, Time Factors, Prosthesis-Related Infections, Hospital Mortality, Guidelines as Topic
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