Valve Surgery for Infective Endocarditis Complicated by Stroke: surgical timing and perioperative neurologic complications
Mots clés
Abstrait
Background: Ischemic and hemorrhagic strokes are dreaded complications of infective endocarditis (IE). Timing of valve surgery for IE patients with stroke remains uncertain. We aimed to study perioperative neurologic complications in relation to surgical timing.
Methods: Study cohort consisted of patients diagnosed with acute IE from January 2010 to December 2016. Early surgery was defined as valve surgery within 14 days of IE diagnosis, and late surgery as after 14. Neurologic complications that occurred within 14 days post-surgery were considered perioperative and classified as new ischemic stroke or hemorrhagic stroke, expansion of an existing intracranial hemorrhage (ICH), and new-onset seizures. We compared perioperative neurologic complications by surgical timing and other variables, including pre-surgical imaging.
Results: Overall, 183 patients underwent valve surgery: 92 had early surgery at median 8 days (IQR 6-11); 91 had late surgery at median 28 days (IQR 19-50). Twenty patients (10.9%) had 24 complications: 11 ischemic, 6 intraparenchymal hemorrhages, 3 subarachnoid hemorrhages (SAH), and 4 new-onset seizures. Rates of neurologic complications were similar for early and late surgery groups (10.9 vs 11%). Enterococcal IE was more common among patients with perioperative neurologic complications (35 vs 12.3%, p<0.01). An acute infarct was present on pre-surgical MRI of 134 patients (74%) and was not associated with perioperative neurologic complications. Thirty-five patients (19.3%) had ICH on pre-surgical imaging. SAH on pre-surgical imaging was associated with developing SAH perioperatively (66.7% vs 13.5%, p<0.01).
Conclusion: Early valve surgery for patients with IE complicated by stroke was not associated with perioperative neurologic complications.
Keywords: Infective endocarditis; embolic stroke; intracranial hemorrhage; perioperative complications; septic emboli; valve replacement; valve surgery.
