1Universitätsklinikum Magdeburg A.ö.R. Klinik für Herz- und Thoraxchirurgie Magdeburg, Deutschland; 2Gesundheitszentrum am Klieversberg HNO Wolfsburg, Deutschland; 3Universitätsklinikum Düsseldorf Klinik für Herzchirurgie Düsseldorf, Deutschland
Aim: Treating infective endocarditis complicated by neurologic events remains challenging and is often based on case-to-case decisions. Identifiying risk factors for postoperative complications is therefore important for decision making in the treatment of complicated infective endocarditis.
Methods: Data from 191 patients undergoing cardiac surgery for infective endocarditis at our institution were collected and the baseline characteristics, operative data and postoperative course were compared between patients with and without preoperative neurological events (ischemic stroke, transient ischemic attack or intrecerebral hemorrhage). It included 151 patients with no preoperative neurologic events and 40 patients with neurological events before the surgery. A univariate logistic regression model was used to determine the impact of preoperative ischemic stroke or hemorrhage on postoperative outcome parameters, and a multivariate logistic regresssion model was used to determine predictors of postoperative neurological events
Results:
Patients in the group with preoperative neurological events had a delayed operation date (33 ± 25 vs. 23 ± 25 days), exhibited a larger vegetation size on the time of surgery (1.27 ± 1.88 vs. 0.68 ± 1.08 cm²) and suffered more often from extracranial embolism (55 vs. 10 %) compared to the other group. Preexisting neurological events also led to significantly more new cerebral embolic (65 vs. 3.3 %) and hemorrhagic events (20 vs. 1.3 %). They also expressed longer mechanical ventilation time (64 ± 89 vs. 59 ± 136 hours) and the risk of requiring neurological rehabilitation after surgery. (26 vs. 9 %).
The risk for new cerebral embolism (OR 133.71), prolonged mechanical ventilation (OR 2.56), intracerebral bleeding (OR 420.00) and discharge to neurological rehabilitation (OR 4.71) was extremely high in patients with preexisting stroke or bleeding. Preoperative TIA (OR 19.45), cerebral embolism (OR 10.59) and lekocytosis (OR 8.36) were predictors of new postoperative neurological events of any kind.
Conclusion: Our study results show that despite delayed operative therapy after the diagnosis of endocarditis, patients with preoperative neurological complications are still under extensive risk for neurological deterioration after surgical treatment of endocarditis.