Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration
Cerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients’ outcomes and define the potential risk factors with regard...
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MDPI AG
2021-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/10/2136 |
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| author | Alexey Dashkevich Georg Bratkov Yupeng Li Dominik Joskowiak Sven Peterss Gerd Juchem Christian Hagl Maximilian Luehr |
| author_facet | Alexey Dashkevich Georg Bratkov Yupeng Li Dominik Joskowiak Sven Peterss Gerd Juchem Christian Hagl Maximilian Luehr |
| author_sort | Alexey Dashkevich |
| collection | DOAJ |
| description | Cerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients’ outcomes and define the potential risk factors with regard to surgical timing for IE patients with preoperative symptomatic cerebral embolism (CE). A total of 119 IE patients with CE were identified and analyzed with regard to operative timing: early (1–7 days), intermediate (8–21 days), and late (>22 days). The preoperative patient data, comorbidities and previous cardiac surgical procedures were analyzed to identify potential predictors and independent risk factors for in-hospital mortality using univariate and multivariate regression analysis. Actuarial survival was estimated by the Kaplan-Meier method. In-hospital mortality for the entire study cohort was 15.1% (<i>n</i> = 18), and in comparison, between groups was found to be highest in the intermediate surgical group (25.7%). Univariate analysis identified preoperative mechanical ventilation dependent respiratory insufficiency (<i>p</i> = 0.006), preoperative renal insufficiency (<i>p</i> = 0.019), age (<i>p</i> = 0.002), large vegetations (<i>p</i> = 0.018) as well as intermediate (<i>p</i> = 0.026), and late (<i>p</i> = 0.041) surgery as predictors of in-hospital mortality. The presence of large vegetations (>8 mm) (<i>p</i> = 0.019) and increased age (<i>p</i> = 0.037)—but not operative timing—were identified as independent risk factors for in-hospital mortality. In the presence of large vegetations (>8 mm), cardiac surgery should be performed early and independently from the entity of cerebral embolic stroke. Postponing surgery to achieve clinical stabilization and better postoperative outcomes of IE patients with CE is reasonable, however, worsening of the disease process with deterioration and resulting heart failure during the first 3 weeks after CE results in a significantly higher in-hospital mortality and inferior long-term survival. |
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| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T11:23:16Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
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| spelling | doaj.art-bf56878d0e36466bbe2837089872e05d2023-11-21T19:51:33ZengMDPI AGJournal of Clinical Medicine2077-03832021-05-011010213610.3390/jcm10102136Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate DeteriorationAlexey Dashkevich0Georg Bratkov1Yupeng Li2Dominik Joskowiak3Sven Peterss4Gerd Juchem5Christian Hagl6Maximilian Luehr7Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Political Science and Economics, Rowan University, Glassboro, NJ 08028, USADepartment of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, GermanyDepartment of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, GermanyCerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients’ outcomes and define the potential risk factors with regard to surgical timing for IE patients with preoperative symptomatic cerebral embolism (CE). A total of 119 IE patients with CE were identified and analyzed with regard to operative timing: early (1–7 days), intermediate (8–21 days), and late (>22 days). The preoperative patient data, comorbidities and previous cardiac surgical procedures were analyzed to identify potential predictors and independent risk factors for in-hospital mortality using univariate and multivariate regression analysis. Actuarial survival was estimated by the Kaplan-Meier method. In-hospital mortality for the entire study cohort was 15.1% (<i>n</i> = 18), and in comparison, between groups was found to be highest in the intermediate surgical group (25.7%). Univariate analysis identified preoperative mechanical ventilation dependent respiratory insufficiency (<i>p</i> = 0.006), preoperative renal insufficiency (<i>p</i> = 0.019), age (<i>p</i> = 0.002), large vegetations (<i>p</i> = 0.018) as well as intermediate (<i>p</i> = 0.026), and late (<i>p</i> = 0.041) surgery as predictors of in-hospital mortality. The presence of large vegetations (>8 mm) (<i>p</i> = 0.019) and increased age (<i>p</i> = 0.037)—but not operative timing—were identified as independent risk factors for in-hospital mortality. In the presence of large vegetations (>8 mm), cardiac surgery should be performed early and independently from the entity of cerebral embolic stroke. Postponing surgery to achieve clinical stabilization and better postoperative outcomes of IE patients with CE is reasonable, however, worsening of the disease process with deterioration and resulting heart failure during the first 3 weeks after CE results in a significantly higher in-hospital mortality and inferior long-term survival.https://www.mdpi.com/2077-0383/10/10/2136infective endocarditis (IE)cerebral embolismischemic strokehemorrhagic strokemitral valveaortic valve |
| spellingShingle | Alexey Dashkevich Georg Bratkov Yupeng Li Dominik Joskowiak Sven Peterss Gerd Juchem Christian Hagl Maximilian Luehr Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration Journal of Clinical Medicine infective endocarditis (IE) cerebral embolism ischemic stroke hemorrhagic stroke mitral valve aortic valve |
| title | Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration |
| title_full | Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration |
| title_fullStr | Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration |
| title_full_unstemmed | Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration |
| title_short | Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism—The Risk of Intermediate Deterioration |
| title_sort | impact of operative timing in infective endocarditis with cerebral embolism the risk of intermediate deterioration |
| topic | infective endocarditis (IE) cerebral embolism ischemic stroke hemorrhagic stroke mitral valve aortic valve |
| url | https://www.mdpi.com/2077-0383/10/10/2136 |
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