Critical potential of early cardiac surgery for infective endocarditis with cardio-embolic strokes

详细信息    查看全文

• 作者：Makoto Suzuki^a ; ^{msuzuki@shi.heart.or.jp} ; Shuichiro Takanashi^b ; Yutaro Ohshima^a ; Yuji Nagatomo^a ; Atsushi Seki^a ; Itaru Takamisawa^a ; Tetsuya Tobaru^a ; Kazuhiro Naito^b ; Hajime Kin^b ; Jun Umemura^a ; Morimasa Takayama^a ; Tetsuya Sumiyoshi^a ; Hitonobu Tomoike^a
• 关键词：Infective endocarditis ; Cardio-embolic strokes ; Early cardiac surgery ; In-hospital mortality
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：222-224
• 全文大小：230 K
• 卷排序：227

文摘

Early cardiac surgery may have a trade-off between stabilized hemodynamics with controlled infection and a risk of peri-operative death in patients with infective endocarditis (IE) complicated with cardio-embolic strokes.MethodsWe retrospectively studied clinical characteristics and outcomes in 68 consecutive patients with IE (mean age, 58 ± 3 years, 62% male) who admitted in our institute during June 2013 and August 2015.ResultsCardio-embolic strokes were noted in 37% of patients (n = 25) with IE and overall in-hospital mortality was 4 times higher in IE with cardio-embolic strokes than IE with an absence of strokes (n = 43) (20% vs. 4.7%, p = 0.045). Bacteremia of Staphylococcus aureus (p = 0.021) and a complication of cardio-embolic strokes (p = 0.031) were independently associated with in-hospital death in those with IE. However, in-hospital mortality was quite low in 19 with early cardiac surgery compared with 6 with conventional treatment in those with cardio-embolic strokes (11% vs. 50%, p = 0.035). Multivariate logistic analysis demonstrated that lack of early cardiac surgery (p = 0.014), a complication of cerebral hemorrhage (p = 0.002), and a presence of refractory heart failure (p = 0.047) were independently associated with in-hospital death in those with IE complicated with cardio-embolic strokes.ConclusionEarly cardiac surgery may provide clinical advantages overcoming peri-operative risks in those with IE complicated with cardio-embolic strokes.