Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery
Introduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery.Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immedi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-12-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2021.716233/full |
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| author | Yolanda Carrascal Yolanda Carrascal Bárbara Segura Eduardo Velasco Ángel L. Guerrero Ángel L. Guerrero |
| author_facet | Yolanda Carrascal Yolanda Carrascal Bárbara Segura Eduardo Velasco Ángel L. Guerrero Ángel L. Guerrero |
| author_sort | Yolanda Carrascal |
| collection | DOAJ |
| description | Introduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery.Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immediate, medium-term, and long-term mortality in patients with active left-sided infective endocarditis who required early surgery (median follow-up: 70.5 months).Results: Of 212 included patients, preoperative SNCs occurred in 22.1%. Independent risk factors for preoperative SNC included early hospital admission (<10 days after symptoms onset), duration of antibiotic therapy <7 days, vegetation diameter > 30 mm, preoperative chronic therapy with steroids, and peripheral embolism. A new postoperative SNC occurred in 12.7% of patients. No significant differences related to preoperative or postoperative SNCs were observed in postoperative mortality (29.8% vs. 31.5%) or during follow-up. No significant differences in postoperative mortality were observed between hemorrhagic or ischemic SNCs. There was a non-significant trend to increased mortality in patients who underwent surgery within 7 days of presenting with SNC (55.5%) compared to those who underwent surgery more than 7 days after SNC (33.3%) (P = 0.171). Concomitant risk of mortality or postoperative hemorrhagic transformation increased when surgery is required during the first week after preoperative SNC (77.5% vs. 25%) (P = 0.017).Conclusions: Patients with active left-sided infective endocarditis who need early hospital admission are at a higher risk of SNC. Mortality is higher in patients who underwent surgery within 7 days of SNC, but mortality of early surgery is acceptable after the first week of preoperative ischemic or hemorrhagic complication. We have not been able to demonstrate that preoperative nor postoperative SNCs predicted a reduced immediate, medium-term, or long-term survival in the population analyzed in this study. |
| first_indexed | 2024-12-17T19:57:14Z |
| format | Article |
| id | doaj.art-240d4043ee4d4b91af31459083539dbc |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-17T19:57:14Z |
| publishDate | 2021-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-240d4043ee4d4b91af31459083539dbc2022-12-21T21:34:34ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2021-12-01810.3389/fcvm.2021.716233716233Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early SurgeryYolanda Carrascal0Yolanda Carrascal1Bárbara Segura2Eduardo Velasco3Ángel L. Guerrero4Ángel L. Guerrero5Cardiac Surgery Department, University Hospital of Valladolid, Valladolid, SpainDepartment of Surgery and Medicine, University of Valladolid, Valladolid, SpainCardiac Surgery Department, University Hospital of Valladolid, Valladolid, SpainCardiac Surgery Department, University Hospital of Valladolid, Valladolid, SpainDepartment of Surgery and Medicine, University of Valladolid, Valladolid, SpainNeurology Department, University Hospital of Valladolid, Valladolid, SpainIntroduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery.Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immediate, medium-term, and long-term mortality in patients with active left-sided infective endocarditis who required early surgery (median follow-up: 70.5 months).Results: Of 212 included patients, preoperative SNCs occurred in 22.1%. Independent risk factors for preoperative SNC included early hospital admission (<10 days after symptoms onset), duration of antibiotic therapy <7 days, vegetation diameter > 30 mm, preoperative chronic therapy with steroids, and peripheral embolism. A new postoperative SNC occurred in 12.7% of patients. No significant differences related to preoperative or postoperative SNCs were observed in postoperative mortality (29.8% vs. 31.5%) or during follow-up. No significant differences in postoperative mortality were observed between hemorrhagic or ischemic SNCs. There was a non-significant trend to increased mortality in patients who underwent surgery within 7 days of presenting with SNC (55.5%) compared to those who underwent surgery more than 7 days after SNC (33.3%) (P = 0.171). Concomitant risk of mortality or postoperative hemorrhagic transformation increased when surgery is required during the first week after preoperative SNC (77.5% vs. 25%) (P = 0.017).Conclusions: Patients with active left-sided infective endocarditis who need early hospital admission are at a higher risk of SNC. Mortality is higher in patients who underwent surgery within 7 days of SNC, but mortality of early surgery is acceptable after the first week of preoperative ischemic or hemorrhagic complication. We have not been able to demonstrate that preoperative nor postoperative SNCs predicted a reduced immediate, medium-term, or long-term survival in the population analyzed in this study.https://www.frontiersin.org/articles/10.3389/fcvm.2021.716233/fullendocarditiscardiac surgeryneurologyneurological complications in cardiac surgeryurgent surgery |
| spellingShingle | Yolanda Carrascal Yolanda Carrascal Bárbara Segura Eduardo Velasco Ángel L. Guerrero Ángel L. Guerrero Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery Frontiers in Cardiovascular Medicine endocarditis cardiac surgery neurology neurological complications in cardiac surgery urgent surgery |
| title | Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery |
| title_full | Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery |
| title_fullStr | Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery |
| title_full_unstemmed | Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery |
| title_short | Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery |
| title_sort | neurological complications in active left sided infective endocarditis requiring early surgery |
| topic | endocarditis cardiac surgery neurology neurological complications in cardiac surgery urgent surgery |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2021.716233/full |
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