The authors aimed to analyze the impact of preoperative septic cerebral embolism on early and late postoperative outcomes in patients with infective endocarditis (IE) undergoing valve surgery. This study utilized data from the Clinical Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry, which includes patients with IE who underwent valve surgery between 1994 and 2018 at six German centers. Patients were categorized based on the presence or absence of preoperative septic cerebral embolism. A total of 4,917 patients were included in the analysis, with 3,909 (79.5 percent) without preoperative septic cerebral embolism and 1,008 (20.5 percent) patients with preoperative septic cerebral embolism. Among patients with preoperative cerebral embolism, 286 (28.4 percent) patients had no stroke signs (silent stroke). There were no statistically significant differences in 30-day mortality (20.1 percent vs. 22.8 percent; p = 0.14) or 5-year survival (47.8 percent vs. 49.1 percent; stratified log-rank p = 0.77) between patients with and without preoperative cerebral embolism. Therefore, the authors conclude that preoperative septic cerebral embolism should not be a major factor in deciding whether to perform surgery in patients with IE requiring heart valve surgery.
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Outcomes Following Heart Valve Surgery in Patients With Infective Endocarditis and Preoperative Septic Cerebral Embolism
Submitted by: Mateo Marin-Cuartas
Source: European Journal of Cardiothoracic Surgery
Keywords:
Author(s): Mateo Marin-Cuartas, Manuela De La Cuesta, Carolyn Weber, Elisabeth Krinke, Artur Lichtenberg, Asen Petrov, Christian Hagl, Hug Aubin, Klaus Matschke, Mahmoud Diab, Maximilian Luehr, Payam Akhyari, Philipp Schnackenburg, Sems-Malte Tugtekin, Shekhar Saha, Torsten Doenst, Thorsten Wahlers, Michael A Borger, Martin Misfeld
2 Comments
Can the authors comment on:
1. What impact of duration after embolization and time of surgery has on post-op. neurological complications
2. Does size /volume of emboli have on brain complications
3. What impact did presence of hemorrhage in the area of septic emboli have on outcomes
Thank you for your comment. I kindly invite you to read the full text, where all these excellent questions are addressed.
1) The information to analyze the impact of duration between embolization and time of surgery on post-op neurological complications is unfortunately not available retrospectively. The primary outcomes of this study were early and late mortality. We did not and cannot (due to lack of data) analyses neurological outcomes.
2) Yes, vegetations >10mm were associated with more frequent preoperative cerebral embolism. We do not know the exact size of the embolized material, and I am also not aware of any routine clinical method to quantify its size.
3)As mentioned in our limitations section, there was a lack of information regarding the specific tomographic characteristics and the extent of the preoperative stroke and bleeding, so we cannot make any statements regarding the impact of new-onset cerebral hemorrhage after embolization. Given the “real-world” nature of our cohort and its large size, we certainly did have patients that should have presented with postoperative hemorrhagic conversion of the stroke (however we do not know the exact number) but still preoperative ceberal embolism seems not to have had an impact on mortality/survival.