Nithya D. Rajeev BS, Markian M. Bojko MD, MPH, Jessica S. Clothier MD, Kamso Okonkwo BA, Kayvan Kazerouni MD, Serge Kobsa MD, PhD
{"title":"术前卒中可预测左侧感染性心内膜炎手术患者术后新的临床显著卒中","authors":"Nithya D. Rajeev BS, Markian M. Bojko MD, MPH, Jessica S. Clothier MD, Kamso Okonkwo BA, Kayvan Kazerouni MD, Serge Kobsa MD, PhD","doi":"10.1016/j.xjon.2024.09.027","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Operative timing remains controversial for patients with left-sided infective endocarditis (LSIE) with preoperative stroke (PREOS). Operative guidelines are determined on the basis of postoperative radiologically confirmed strokes (RCS). We evaluated the impact of PREOS on surgical outcomes.</div></div><div><h3>Methods</h3><div>Over 15 years, 331 patients underwent valvular surgery for LSIE at our center. PREOS (n = 71, 21%) and non-PREOS (n = 260, 79%) cohorts were identified. Propensity score matching was performed. Logistic regression identified risk factors for postoperative clinical stroke (PCS, defined as any new postoperative neurologic deficit), RCS and mortality.</div></div><div><h3>Results</h3><div>Among patients with PREOS, 24 of 71 (34%) had a hemorrhagic component, 34 of 71 (48%) were within 2 weeks of surgery, 46 of 71 (65%) experienced residual deficits, and 2 of 71 (3%) experienced hemorrhagic conversion postoperatively. Operative mortality was 24 of 331 (7%) and did not significantly differ between groups (<em>P</em> = .083). Patients with PREOS had a greater incidence of PCS (<em>P</em> = .001), repeat imaging of the head (<em>P</em> < .001), new renal failure (<em>P</em> = .006), and nonhome discharges (<em>P</em> < .001). Propensity score matching upheld these trends. Logistic regression identified PREOS as a risk factor for PCS (odds ratio [OR], 8.76; <em>P</em> < .001). Intraoperative abscess (OR, 4.83; <em>P</em> = .013), cardiogenic shock (OR 8.51; <em>P</em> = .023), and tricuspid procedures (OR 5.03; <em>P</em> = .02) were RCS risk factors. PREOS (OR 3.12; <em>P</em> = .025), preoperative renal failure (OR 2.67; <em>P</em> = .043), immunosuppression (OR 7.09; <em>P</em> = .022), tricuspid regurgitation (OR 4.36; <em>P</em> = .011), and aortic valve procedures (OR 4.38; <em>P</em> = .033) were risk factors for mortality.</div></div><div><h3>Conclusions</h3><div>Among patients with LSIE undergoing surgery, PREOS is a risk factor for PCS and new renal failure. Patients with PREOS may require greater level of care upon discharge and may benefit from more stringent preoperative evaluation.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 170-184"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Preoperative stroke predicts new postoperative clinically significant stroke in patients undergoing surgery for left-sided infective endocarditis\",\"authors\":\"Nithya D. Rajeev BS, Markian M. Bojko MD, MPH, Jessica S. Clothier MD, Kamso Okonkwo BA, Kayvan Kazerouni MD, Serge Kobsa MD, PhD\",\"doi\":\"10.1016/j.xjon.2024.09.027\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>Operative timing remains controversial for patients with left-sided infective endocarditis (LSIE) with preoperative stroke (PREOS). Operative guidelines are determined on the basis of postoperative radiologically confirmed strokes (RCS). We evaluated the impact of PREOS on surgical outcomes.</div></div><div><h3>Methods</h3><div>Over 15 years, 331 patients underwent valvular surgery for LSIE at our center. PREOS (n = 71, 21%) and non-PREOS (n = 260, 79%) cohorts were identified. Propensity score matching was performed. Logistic regression identified risk factors for postoperative clinical stroke (PCS, defined as any new postoperative neurologic deficit), RCS and mortality.</div></div><div><h3>Results</h3><div>Among patients with PREOS, 24 of 71 (34%) had a hemorrhagic component, 34 of 71 (48%) were within 2 weeks of surgery, 46 of 71 (65%) experienced residual deficits, and 2 of 71 (3%) experienced hemorrhagic conversion postoperatively. Operative mortality was 24 of 331 (7%) and did not significantly differ between groups (<em>P</em> = .083). Patients with PREOS had a greater incidence of PCS (<em>P</em> = .001), repeat imaging of the head (<em>P</em> < .001), new renal failure (<em>P</em> = .006), and nonhome discharges (<em>P</em> < .001). Propensity score matching upheld these trends. Logistic regression identified PREOS as a risk factor for PCS (odds ratio [OR], 8.76; <em>P</em> < .001). Intraoperative abscess (OR, 4.83; <em>P</em> = .013), cardiogenic shock (OR 8.51; <em>P</em> = .023), and tricuspid procedures (OR 5.03; <em>P</em> = .02) were RCS risk factors. PREOS (OR 3.12; <em>P</em> = .025), preoperative renal failure (OR 2.67; <em>P</em> = .043), immunosuppression (OR 7.09; <em>P</em> = .022), tricuspid regurgitation (OR 4.36; <em>P</em> = .011), and aortic valve procedures (OR 4.38; <em>P</em> = .033) were risk factors for mortality.</div></div><div><h3>Conclusions</h3><div>Among patients with LSIE undergoing surgery, PREOS is a risk factor for PCS and new renal failure. Patients with PREOS may require greater level of care upon discharge and may benefit from more stringent preoperative evaluation.</div></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"24 \",\"pages\":\"Pages 170-184\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273624002808\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273624002808","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Preoperative stroke predicts new postoperative clinically significant stroke in patients undergoing surgery for left-sided infective endocarditis
Objective
Operative timing remains controversial for patients with left-sided infective endocarditis (LSIE) with preoperative stroke (PREOS). Operative guidelines are determined on the basis of postoperative radiologically confirmed strokes (RCS). We evaluated the impact of PREOS on surgical outcomes.
Methods
Over 15 years, 331 patients underwent valvular surgery for LSIE at our center. PREOS (n = 71, 21%) and non-PREOS (n = 260, 79%) cohorts were identified. Propensity score matching was performed. Logistic regression identified risk factors for postoperative clinical stroke (PCS, defined as any new postoperative neurologic deficit), RCS and mortality.
Results
Among patients with PREOS, 24 of 71 (34%) had a hemorrhagic component, 34 of 71 (48%) were within 2 weeks of surgery, 46 of 71 (65%) experienced residual deficits, and 2 of 71 (3%) experienced hemorrhagic conversion postoperatively. Operative mortality was 24 of 331 (7%) and did not significantly differ between groups (P = .083). Patients with PREOS had a greater incidence of PCS (P = .001), repeat imaging of the head (P < .001), new renal failure (P = .006), and nonhome discharges (P < .001). Propensity score matching upheld these trends. Logistic regression identified PREOS as a risk factor for PCS (odds ratio [OR], 8.76; P < .001). Intraoperative abscess (OR, 4.83; P = .013), cardiogenic shock (OR 8.51; P = .023), and tricuspid procedures (OR 5.03; P = .02) were RCS risk factors. PREOS (OR 3.12; P = .025), preoperative renal failure (OR 2.67; P = .043), immunosuppression (OR 7.09; P = .022), tricuspid regurgitation (OR 4.36; P = .011), and aortic valve procedures (OR 4.38; P = .033) were risk factors for mortality.
Conclusions
Among patients with LSIE undergoing surgery, PREOS is a risk factor for PCS and new renal failure. Patients with PREOS may require greater level of care upon discharge and may benefit from more stringent preoperative evaluation.
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