The Influence of Preoperative Neurological Complications on Outcomes after Surgery for Infective Endocarditis

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2024-03-06 DOI:10.1155/2024/9575684

Mohammed Al-Tawil, Christine Friedrich, Kira Mandler, Julia Brandl, Mohamed Salem, Jan Schoettler, Nora de Silva, Thomas Puehler, Jochen Cremer, Assad Haneya

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Abstract

Background. Infective endocarditis (IE) is considered a life-threatening cardiac infection with a predilection to involve heart valves. One of the most feared complications of IE is the development of new-onset neurological complications (NCs). The aim of this study is to compare the short- and long-term outcomes of surgery in patients with IE presenting with vs. without NCs. Methods. We retrospectively reviewed patient records which were regularly collected in our institutional database. Between January 2002 and August 2020, 438 consecutive patients who underwent open cardiac surgery in our university hospital due to IE were included in the retrospective study. Results. Of the total cohort, 89 patients (20.3%) had preoperative NCs. Patients in the NC group were more likely to be female (33.7% vs. 23.5%; P = 0.049), had more acute kindly injury at presentation (22.5% vs. 10.0%; P = 0.002), were more likely to be admitted to ICU (36.0% vs. 18.3%; P < 0.001), and had significantly more vegetations (84.3% vs. 69.8%; P = 0.006) and overall higher preoperative embolization (92.1% vs. 11.7%; P < 0.001). Staphylococcus aureus as causative organism of IE was significantly higher in the NC group (35.2% vs. 16.1%; P < 0.001). Patients in the NC group had significantly higher affection of the mitral valve. There was no difference in postoperative outcomes between the two groups. The long-term survival was also similar in both groups. Preoperative atrial fibrillation (adjusted odds ratio (aOR): 2.03; 95% CI [1.04–3.93]; P = 0.037) and Staphylococcus aureus IE (aOR: 2.60; 95% CI [1.4–4.8]; P = 0.002) were independent risk factors of developing NCs, while previous endocarditis was a protective factor (aOR: 0.33; 95% CI [0.11–0.99]; P = 0.048). Conclusion. Our study emphasizes the shared risk factors between mortality and developing NCs. NCs are critical in IE’s clinical presentation, but they do not independently predict short- or long-term survival following surgery for IE.

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术前神经并发症对感染性心内膜炎手术后疗效的影响

背景。感染性心内膜炎（IE）被认为是一种危及生命的心脏感染，并倾向于累及心脏瓣膜。感染性心内膜炎最可怕的并发症之一是新发神经系统并发症（NCs）。本研究的目的是比较有 NC 和无 NC 的 IE 患者手术的短期和长期疗效。研究方法我们回顾性地查看了本机构数据库中定期收集的患者病历。在 2002 年 1 月至 2020 年 8 月期间，438 名因 IE 而在本大学医院接受开胸心脏手术的连续患者被纳入了这项回顾性研究。研究结果在所有患者中，有 89 名患者（20.3%）在术前出现了 NC。NC组患者更可能是女性（33.7% vs. 23.5%；P=0.049），发病时有更多急性心肌损伤（22.5% vs. 10.0%；P=0.002），更可能入住重症监护室（36.0% vs. 18.3%；P<0.001），有明显更多的植被（84.3% vs. 69.8%；P=0.006），术前栓塞率总体更高（92.1% vs. 11.7%；P<0.001）。金黄色葡萄球菌作为 IE 的致病菌，在 NC 组明显较高（35.2% 对 16.1%；P<0.001）。NC组患者的二尖瓣感染率明显更高。两组患者的术后结果没有差异。两组患者的长期生存率也相似。术前心房颤动（调整后比值比 (aOR)：2.03；95% CI [1.04-3.93]；P=0.037）和金黄色葡萄球菌 IE（aOR：2.60；95% CI [1.4-4.8]；P=0.002）是发生 NC 的独立危险因素，而既往患过心内膜炎则是一个保护因素（aOR：0.33；95% CI [0.11-0.99]；P=0.048）。结论我们的研究强调了死亡率与罹患NCs之间的共同风险因素。NCs在IE的临床表现中至关重要，但并不能独立预测IE手术后的短期或长期存活率。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.