Early Surgery for Infective Endocarditis Complicated With Neurologic Injury.
J Cardiothorac Vasc Anesth
; 38(5): 1161-1168, 2024 May.
Article
in En
| MEDLINE
| ID: mdl-38467525
ABSTRACT
OBJECTIVES:
To estimate the association between early surgery and the risk of mortality in patients with left-sided infective endocarditis in the context of stroke.DESIGN:
Retrospective cohort study.SETTING:
This study was a multiinstitution study based on the Chang Gung Research Database, which contains electronic medical records from 7 hospitals in northern and southern Taiwan; these include 2 medical centers, 2 regional hospitals, and 3 district hospitals.PARTICIPANTS:
Patients with active left-sided infective endocarditis who underwent valve surgery between September 2002 and December 2018.INTERVENTIONS:
The authors divided patients into 2 groups, with versus without preoperative neurologic complications, had undergone early (within 7 d) or later surgery, and with brain ischemia or hemorrhage. MEASUREMENTS AND MAINRESULTS:
Three hundred ninety-two patients with a median time from diagnosis to surgery of 6 days were included. No significant differences in postoperative stroke, in-hospital mortality, or follow-up outcomes were observed between the patients with and without neurologic complications. Among the patients with preoperative neurologic complications, patients who underwent early surgery had a lower 30-day postoperative mortality rate (13.1% v 25.8%; hazard ratio, 0.21; 95% CI 0.07-0.67). In the subgroup analysis of the comparison between brain ischemia and hemorrhage groups, there was no significant between-group difference in the in-hospital outcomes or outcomes after discharge.CONCLUSIONS:
Early cardiac surgery may be associated with more favorable clinical outcomes in patients with preoperative neurologic complications. Thus, preoperative neurologic complications should not delay surgical interventions.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Brain Ischemia
/
Stroke
/
Endocarditis
/
Endocarditis, Bacterial
/
Nervous System Diseases
Limits:
Humans
Language:
En
Journal:
J Cardiothorac Vasc Anesth
Journal subject:
ANESTESIOLOGIA
/
CARDIOLOGIA
Year:
2024
Document type:
Article
Affiliation country:
Taiwan