Timing for surgery in patients with infective endocarditis and cerebrovascular complications—waiting may be best but results of early surgery are acceptable and ...
NJ Howell... - European Journal of Cardio- ..., 2012 - Cerebral complications associated with IE appear to be similar in both aortic or mitral
infections. These cerebrovascular complications may be due to either embolic stroke affecting
between 8 and 15% of patients, or cerebral haemorrhage affecting 23%. Of the total ...
The timing of surgery for patients with infective endocarditis (IE) remains contentious, but over the last decade the number of patients operated on during the active phase has increased significantly [1, 2].
Cerebral complications associated with IE appear to be similar in both aortic or mitral infections. These cerebrovascular complications may be due to either embolic stroke affecting between 8 and 15% of patients, or cerebral haemorrhage affecting 2–3%. Of the total number embolic events associated with endocarditis 65% affect the central nervous system, the incidence of which has been reported as between 9 and 40% [3, 4]. This range may be due to the difference in preponderance of the causative organisms to embolize; Staphylococcus aureus and Streptococcus viridans have both been reported to be associated with an increased risk of neurological events [3–5].
Systemic heparinization and cardiopulmonary bypass in patients with cerebrovascular complications carry a risk of further neurological injury. Cerebral infarctions may be complicated by secondary haemorrhage, and haemorrhagic strokes may be extended. Periods of hypo-perfusion either during the period of cardiopulmonary bypass, or post-operatively during periods of low cardiac output may exacerbate any pre-existing neurological injury.
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Timing for surgery in patients with infective endocarditis and cerebrovascular complications—waiting may be best but results of early surgery are acceptable and ... |
