Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery

Introduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery.Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immedi...

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Autores principales:	Yolanda Carrascal, Bárbara Segura, Eduardo Velasco, Ángel L. Guerrero
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	endocarditis cardiac surgery neurology neurological complications in cardiac surgery urgent surgery Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/240d4043ee4d4b91af31459083539dbc
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spelling	oai:doaj.org-article:240d4043ee4d4b91af31459083539dbc2021-12-03T05:02:19ZNeurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery2297-055X10.3389/fcvm.2021.716233https://doaj.org/article/240d4043ee4d4b91af31459083539dbc2021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.716233/fullhttps://doaj.org/toc/2297-055XIntroduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery.Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immediate, medium-term, and long-term mortality in patients with active left-sided infective endocarditis who required early surgery (median follow-up: 70.5 months).Results: Of 212 included patients, preoperative SNCs occurred in 22.1%. Independent risk factors for preoperative SNC included early hospital admission (<10 days after symptoms onset), duration of antibiotic therapy <7 days, vegetation diameter > 30 mm, preoperative chronic therapy with steroids, and peripheral embolism. A new postoperative SNC occurred in 12.7% of patients. No significant differences related to preoperative or postoperative SNCs were observed in postoperative mortality (29.8% vs. 31.5%) or during follow-up. No significant differences in postoperative mortality were observed between hemorrhagic or ischemic SNCs. There was a non-significant trend to increased mortality in patients who underwent surgery within 7 days of presenting with SNC (55.5%) compared to those who underwent surgery more than 7 days after SNC (33.3%) (P = 0.171). Concomitant risk of mortality or postoperative hemorrhagic transformation increased when surgery is required during the first week after preoperative SNC (77.5% vs. 25%) (P = 0.017).Conclusions: Patients with active left-sided infective endocarditis who need early hospital admission are at a higher risk of SNC. Mortality is higher in patients who underwent surgery within 7 days of SNC, but mortality of early surgery is acceptable after the first week of preoperative ischemic or hemorrhagic complication. We have not been able to demonstrate that preoperative nor postoperative SNCs predicted a reduced immediate, medium-term, or long-term survival in the population analyzed in this study.Yolanda CarrascalYolanda CarrascalBárbara SeguraEduardo VelascoÁngel L. GuerreroÁngel L. GuerreroFrontiers Media S.A.articleendocarditiscardiac surgeryneurologyneurological complications in cardiac surgeryurgent surgeryDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	endocarditis cardiac surgery neurology neurological complications in cardiac surgery urgent surgery Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	endocarditis cardiac surgery neurology neurological complications in cardiac surgery urgent surgery Diseases of the circulatory (Cardiovascular) system RC666-701 Yolanda Carrascal Yolanda Carrascal Bárbara Segura Eduardo Velasco Ángel L. Guerrero Ángel L. Guerrero Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery
description	Introduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery.Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immediate, medium-term, and long-term mortality in patients with active left-sided infective endocarditis who required early surgery (median follow-up: 70.5 months).Results: Of 212 included patients, preoperative SNCs occurred in 22.1%. Independent risk factors for preoperative SNC included early hospital admission (<10 days after symptoms onset), duration of antibiotic therapy <7 days, vegetation diameter > 30 mm, preoperative chronic therapy with steroids, and peripheral embolism. A new postoperative SNC occurred in 12.7% of patients. No significant differences related to preoperative or postoperative SNCs were observed in postoperative mortality (29.8% vs. 31.5%) or during follow-up. No significant differences in postoperative mortality were observed between hemorrhagic or ischemic SNCs. There was a non-significant trend to increased mortality in patients who underwent surgery within 7 days of presenting with SNC (55.5%) compared to those who underwent surgery more than 7 days after SNC (33.3%) (P = 0.171). Concomitant risk of mortality or postoperative hemorrhagic transformation increased when surgery is required during the first week after preoperative SNC (77.5% vs. 25%) (P = 0.017).Conclusions: Patients with active left-sided infective endocarditis who need early hospital admission are at a higher risk of SNC. Mortality is higher in patients who underwent surgery within 7 days of SNC, but mortality of early surgery is acceptable after the first week of preoperative ischemic or hemorrhagic complication. We have not been able to demonstrate that preoperative nor postoperative SNCs predicted a reduced immediate, medium-term, or long-term survival in the population analyzed in this study.
format	article
author	Yolanda Carrascal Yolanda Carrascal Bárbara Segura Eduardo Velasco Ángel L. Guerrero Ángel L. Guerrero
author_facet	Yolanda Carrascal Yolanda Carrascal Bárbara Segura Eduardo Velasco Ángel L. Guerrero Ángel L. Guerrero
author_sort	Yolanda Carrascal
title	Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery
title_short	Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery
title_full	Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery
title_fullStr	Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery
title_full_unstemmed	Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery
title_sort	neurological complications in active left-sided infective endocarditis requiring early surgery
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/240d4043ee4d4b91af31459083539dbc
work_keys_str_mv	AT yolandacarrascal neurologicalcomplicationsinactiveleftsidedinfectiveendocarditisrequiringearlysurgery AT yolandacarrascal neurologicalcomplicationsinactiveleftsidedinfectiveendocarditisrequiringearlysurgery AT barbarasegura neurologicalcomplicationsinactiveleftsidedinfectiveendocarditisrequiringearlysurgery AT eduardovelasco neurologicalcomplicationsinactiveleftsidedinfectiveendocarditisrequiringearlysurgery AT angellguerrero neurologicalcomplicationsinactiveleftsidedinfectiveendocarditisrequiringearlysurgery AT angellguerrero neurologicalcomplicationsinactiveleftsidedinfectiveendocarditisrequiringearlysurgery
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Neurological Complications in Active Left-Sided Infective Endocarditis Requiring Early Surgery

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