Surgical Management of Infective Endocarditis Complicated by Embolic Stroke: Early versus Delayed Surgery.
10.5090/kjtcs.2011.44.5.332
- Author:
Gwan Sic KIM
1
;
Joon Bum KIM
;
Sung Ho JUNG
;
Tae Jin YUN
;
Suk Jung CHOO
;
Cheol Hyun CHUNG
;
Jae Won LEE
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea. jwlee@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Endocarditis;
Embolism;
Stroke;
Neurologic manifestations;
Cerebral complicaton
- MeSH:
Embolism;
Endocarditis;
Follow-Up Studies;
Humans;
Infarction;
Neurologic Manifestations;
Stroke;
Survival Rate;
Survivors;
Thoracic Surgery
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2011;44(5):332-337
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The optimal timing of surgery for infective endocarditis complicated by embolic stroke is unclear. We compared early versus delayed surgery in these patients. MATERIALS AND METHODS: Between 1992 and 2007, 56 consecutive patients underwent open cardiac surgery for the treatment of infective endocarditis complicated by acute septic embolic stroke, 34 within 2 weeks (early group) and 22 more than 2 weeks (delayed group) after the onset of stroke. RESULTS: The mean age at time of surgery was 45.7+/-14.8 years. Stroke was ischemic in 42 patients and hemorrhagic in 14. Patients in the early group were more likely to have highly mobile, large (>1 cm in diameter) vegetation and less likely to have hemorrhagic infarction than those in the delayed group. There were two (3.7%) intraoperative deaths, both in the early group and attributed to neurologic aggravation. Among the 54 survivors, 4 (7.1%), that is, 2 in each group, showed neurologic aggravation. During a median follow-up of 61.7 months (range, 0.4~170.4 months), there were 5 late deaths. Overall 5-year neurologic aggravation-free survival rates were 79.1+/-7.0% in the early group and 90.9+/-6.1% in the delayed group (p=0.113). CONCLUSION: Outcomes of early operation for infective endocarditis in stroke patients were similar to those of the conventional approach. Early surgical intervention may be preferable for patients at high risk of life-threatening septic embolism.
