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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 123] [Impact Index Per Article: 123.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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2
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Boukobza M, Ilic-Habensus E, Mourvillier B, Duval X, Laissy JP. Brain abscesses in infective endocarditis: contemporary profile and neuroradiological findings. Infection 2023; 51:1431-1444. [PMID: 36853493 DOI: 10.1007/s15010-023-02008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 02/16/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Brain abscesses (BA) are severe lesions in the course of infective endocarditis (IE). We compare the bacteriological, clinical data, background, associated lesions, and outcome of IE patients with and without BAs, and assess the MRI characteristics of BAs. METHODS Retrospective study of 351 consecutive patients with definite IE (2005-2020) and at least one brain MRI. Patients with and without BAs were compared. RESULTS Twenty patients (5.7%) had BA (80% men; median age: 44.9 ± 11.5). They were younger (p = 0.035) and had a higher rate of predisposing factors (previous IE 20% vs 2.2%, p = 0.03), intravenous drug use [25% vs 2.2%; p < 0.0001]), underlying conditions (HIV infection, 20% vs 2.2%, p < 0.0001; alcohol abuse, 20% vs 2.2% p < 0.0001]; liver disease p = 0.04; hemodialysis, p = 0.001; type 2 diabetes, p = 0.001), bacterial meningitis (p = 0.0029), rare species involvement (35% vs 7%, p < 0.0006) and extra-cerebral abscesses (p = 0.0001) compared to patients without BA. Valve vegetations were larger in Group 1 (p = 0.046). Clinical presentation could suggest the diagnosis of BA in only 7/20 (35%) patients. MR identified 58 BAs (mean/patient 2.9; range 2-12): often multiple (80%), bilateral (55%) and ≤ 10 mm (72%). The presence of BA did not modify cardiac surgery indication and timing. Favorable outcome was observed in 85% of patients. CONCLUSION Rates of predisposing, underlying conditions, rare IE agents, meningitis and metastatic abscesses are significantly higher in BA-IE patients. As BAs can develop in asymptomatic IE patients, the impact of brain MRI on their management needs thoroughly to be further investigated.
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Affiliation(s)
- Monique Boukobza
- Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France.
| | - Emila Ilic-Habensus
- Clinical Investigation Center, Hopital Bichat, Claude-Bernard, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
| | - Bruno Mourvillier
- Medical Intensive Care Unit, University Hospital of Reims, Reims, France
| | - Xavier Duval
- Clinical Investigation Center, Hopital Bichat, Claude-Bernard, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM Clinical Investigation Center 007, Paris, France
- INSERM U738, Paris University, Paris, France
| | - Jean-Pierre Laissy
- Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France
- INSERM U1148, Paris University, Paris, France
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3
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Kremer J, Jahn J, Klein S, Farag M, Borst T, Karck M. Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke. J Cardiovasc Dev Dis 2023; 10:356. [PMID: 37623369 PMCID: PMC10455129 DOI: 10.3390/jcdd10080356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes imperative. METHODS Out of 688 patients who were surgically treated for left-sided infective endocarditis, 187 presented with preoperative neurological events. The date of cerebral stroke onset was documented in 147 patients. The patients were stratified according to timing of surgery: 61 in the early group (0-7 days) vs. 86 in the delayed group (>7 days). Postoperative neurological outcome was assessed by the modified Rankin Scale. RESULTS Preoperative sepsis was more prevalent in patients with preoperative neurological complications (46.0% vs. 29.5%, p < 0.001). Patients with haemorrhagic stroke were operated on later (19.8% vs. 3.3%, p = 0.003). Postoperative cerebrovascular accidents were comparable between both groups (p = 0.13). Overall, we observed good neurological outcomes (p = 0.80) and a high recovery rate, with only 5% of cases showing neurological deterioration after surgery (p = 0.29). In-hospital mortality and long-term survival were not significantly different in the early and delayed surgery groups (log-rank, p = 0.22). CONCLUSIONS Early valve surgery in high-risk patients with infective endocarditis and stroke can be performed safely and is not associated with worse outcomes.
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Affiliation(s)
- Jamila Kremer
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Joshua Jahn
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Sabrina Klein
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
| | - Mina Farag
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Tobias Borst
- Pharmacy Department, Erlangen University Hospital, Palmsanlage 3, 91054 Erlangen, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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Sharma M, Davis AP. Adding Fuel to the Fire: Infective Endocarditis and the Challenge of Cerebrovascular Complications. Curr Cardiol Rep 2023; 25:349-356. [PMID: 36971959 DOI: 10.1007/s11886-023-01856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE OF REVIEW Infective endocarditis is a deadly disease and made more deadly by neurologic complications. We review the cerebrovascular complications of infective endocarditis and focus our discussion on medical and surgical management. RECENT FINDINGS While management of stroke in the setting of infective endocarditis differs from standard stroke treatment, mechanical thrombectomy has proven safe and successful. Optimal timing of cardiac surgery in the setting of stroke remains an area of debate, but additional observational studies continue to add more detail to the discussion. Cerebrovascular complications in the setting of infective endocarditis remain a high stakes clinical challenge. Timing of cardiac surgery in IE complicated by stroke exemplifies these dilemmas. While more studies have suggested that earlier cardiac surgery is likely safe for those with small ischemic infarcts, there remains a need for more data defining optimal timing of surgery in all forms of cerebrovascular involvement.
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Affiliation(s)
- Malveeka Sharma
- Department of Neurology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359775, Seattle, WA, 98104-2420, USA
| | - Arielle P Davis
- Department of Neurology, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359775, Seattle, WA, 98104-2420, USA.
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5
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Jain A, Subramani S, Gebhardt B, Hauser J, Bailey C, Ramakrishna H. Infective Endocarditis-Update for the Perioperative Clinician. J Cardiothorac Vasc Anesth 2023; 37:637-649. [PMID: 36725476 DOI: 10.1053/j.jvca.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
Infective endocarditis is a common pathology routinely encountered by perioperative physicians. There has been a need for a comprehensive review of this important topic. In this expert review, the authors discuss in detail the incidence, etiology, definition, microbiology, and trends of infective endocarditis. The authors discuss the clinical and imaging criteria for diagnosing infective endocarditis and the perioperative considerations for the same. Other imaging modalities to evaluate infective endocarditis also are discussed. Furthermore, the authors describe in detail the clinical risk scores that are used for determining clinical prognostic criteria and how they are tied to the current societal guidelines. Knowledge about native and prosthetic valve endocarditis, with emphasis on the timing of surgical intervention-focused surgical approaches and analysis of current outcomes, are critical to managing such patients, especially high-risk patients like those with heart failure, patients with intravenous drug abuse, and with internal pacemakers and defibrillators in situ. And lastly, with the advancement of percutaneous transcatheter valves becoming a norm for the management of various valvular pathologies, the authors discuss an in-depth review of transcatheter valve endocarditis with a focus on its incidence, the timing of surgical interventions, outcome data, and management of high-risk patients.
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Affiliation(s)
- Ankit Jain
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Sudhakar Subramani
- Department of Anesthesiology and Perioperative Medicine, University of Iowa, Iowa City, IA
| | - Brian Gebhardt
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, MA
| | - Joshua Hauser
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Caryl Bailey
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia & Augusta University, Augusta, GA
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Mayne EW, Mailo JA, Pabst L, Pulcine E, Harrar DB, Waak M, Rafay MF, Hassanein SM, Amlie-Lefond C, Jordan LC. Pediatric Stroke and Cardiac Disease: Challenges in Recognition and Management. Semin Pediatr Neurol 2022; 43:100992. [PMID: 36344023 PMCID: PMC9719802 DOI: 10.1016/j.spen.2022.100992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elizabeth W Mayne
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA.
| | - Janette A Mailo
- Division of Pediatric Neurology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Pabst
- Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital, Columbus, OH
| | - Elizabeth Pulcine
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Dana B Harrar
- Division of Neurology, Children's National Hospital, George Washington University School of Medicine, Washington, DC
| | - Michaela Waak
- Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland, Australia; Pediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia
| | - Mubeen F Rafay
- Children's Hospital Winnipeg, University of Manitoba, Children's Hospital Research Institute of Manitoba, Manitoba, Canada
| | - Sahar Ma Hassanein
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Catherine Amlie-Lefond
- Department of Neurology, Department of Neurological Surgery, University of Washington, Seattle, WA
| | - Lori C Jordan
- Department of Pediatrics, Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN
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7
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Optimal Timing for Cardiac Surgery in Infective Endocarditis with Neurological Complications: A Narrative Review. J Clin Med 2022; 11:jcm11185275. [PMID: 36142922 PMCID: PMC9501443 DOI: 10.3390/jcm11185275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/26/2022] [Accepted: 09/01/2022] [Indexed: 11/17/2022] Open
Abstract
In patients with infective endocarditis and neurological complications, the optimal timing for cardiac surgery is unclear due to the varied risk of clinical deterioration when early surgery is performed. The aim of this review is to summarize the best evidence on the optimal timing for cardiac surgery in the presence of each type of neurological complication. An English literature search was carried out from June 2018 through July 2022. The resulting selection, comprising observational studies, clinical trials, systematic reviews and society guidelines, was organized into four sections according to the four groups of neurological complications: ischemic, hemorrhagic, infectious, and asymptomatic complications. Cardiac surgery could be performed without delay in cases of ischemic vascular neurological complication (provided the absence of severe damage, which can be avoided with the performance of mechanical thrombectomy in cases of major stroke), as well as infectious or asymptomatic complications. In the presence of intracranial hemorrhage, a delay of four weeks is recommended for most cases, although recent studies have suggested that performing cardiac surgery within four weeks could be a suitable option for selected cases. The findings of this review are mostly in line with the recommendations of the current European and American infective endocarditis guidelines.
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Vervoort D, An KR, Elbatarny M, Tam DY, Quastel A, Verma S, Connelly KA, Yanagawa B, Fremes SE. Dealing with the epidemic of endocarditis in people who inject drugs. Can J Cardiol 2022; 38:1406-1417. [PMID: 35691567 DOI: 10.1016/j.cjca.2022.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/18/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Abstract
North America is facing an opioid epidemic and growing illicit drug supply, contributing to growing numbers of injection drug use-related infective endocarditis (IDU-IE). Patients with IDU-IE have high early and late mortality. Patients with IDU-IE more commonly present with right-sided IE compared to those with non-IDU-IE and a majority are a result of S. aureus. While most patients can be successfully managed with intravenous antibiotic treatment, surgery is often required in part related to high relapse rates, potential treatment biases, and more aggressive pathophysiology in some. Multidisciplinary management as endocarditis teams, including not only cardiologists and cardiac surgeons but also infectious disease specialists, drug addiction experts, social workers, neurologists and/or neurosurgeons, is essential to best manage substance use disorder and facilitate safe discharge to home and society. Structural and population-level interventions, such as harm reduction programs, are necessary to reduce IDU-IE relapse rates in the community and other IDU-related health concerns such as overdoses. In this review, we describe the pathophysiological, clinical, surgical, social, and ethical characteristics of IDU-IE and the management thereof. We present the most recent clinical guidelines for this condition and discuss existing gaps in knowledge to guide future research, practice changes, and policy interventions.
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Affiliation(s)
- Dominique Vervoort
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Malak Elbatarny
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Adam Quastel
- Department of Psychiatry, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Division of Cardiology, Department of Medicine, St Michael's Hospital, Keenan Research Centre for Biomedical Research, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada; Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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9
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Musleh R, Schlattmann P, Caldonazo T, Kirov H, Witte OW, Doenst T, Günther A, Diab M. Surgical Timing in Patients With Infective Endocarditis and With Intracranial Hemorrhage: A Systematic Review and Meta‐Analysis. J Am Heart Assoc 2022; 11:e024401. [PMID: 35574955 PMCID: PMC9238556 DOI: 10.1161/jaha.121.024401] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Intracranial hemorrhage (ICH) is one of the main causes for lack of surgery in patients with infective endocarditis (IE), despite the presence of surgical indications. We aimed to evaluate the impact of early surgery in patients with IE and with ICH on postoperative neurological deterioration and all‐cause mortality and to elucidate the risk of 30‐day mortality in patients who were denied surgery. Methods and Results Three libraries (MEDLINE, EMBASE, and Cochrane Library) were assessed. The primary outcome was all‐cause mortality, and the secondary outcome was neurological deterioration. Inverse variance method and random model were performed. We identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early versus late) and were included in the meta‐analysis. Only one study examined the fate of patients with IE and with ICH who were treated conservatively despite having an indication for cardiac surgery, showing higher mortality rates than those who underwent surgery (11.8% versus 2.5%). We found no significant association between early surgery, regardless of its definition, and a higher mortality (odds ratio [OR], 1.69; 95% CI, 0.95–3.02). Early surgery was associated with higher risk for neurological deterioration (OR, 2.00; 95% CI, 1.10–3.65). Conclusions Cardiac surgery for IE within 30 days of ICH was not associated with higher mortality, but with an increased rate of neurological deterioration. The 30‐day mortality in patients with IE and with ICH who were denied surgery has not yet been sufficiently investigated. This patient group should be analyzed in future studies in more detail.
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Affiliation(s)
- Rita Musleh
- Department of NeurologyJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Peter Schlattmann
- Department of Medical StatisticsComputer Science and Data ScienceJena University HospitalFriedrich‐Schiller University JenaJenaGermany
| | - Túlio Caldonazo
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Hristo Kirov
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Otto W. Witte
- Department of NeurologyJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Torsten Doenst
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Albrecht Günther
- Department of NeurologyJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
| | - Mahmoud Diab
- Department of Cardiothoracic SurgeryJena University HospitalFriedrich‐Schiller‐University JenaJenaGermany
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10
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Ruttmann E, Abfalterer H, Wagner J, Grimm M, Müller L, Bates K, Ulmer H, Bonaros N. Endocarditis-related stroke is not a contraindication for early cardiac surgery: an investigation among 440 patients with left-sided endocarditis. Eur J Cardiothorac Surg 2021; 58:1161-1167. [PMID: 33057727 DOI: 10.1093/ejcts/ezaa239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES A treatment dilemma arises when surgery is indicated in patients with infective endocarditis (IE) complicated by stroke. Neurologists recommend surgery to be postponed for at least 1 month. This study aims to investigate the neurological complication rate and neurological recovery potential in patients with IE-related stroke. METHODS A total of 440 consecutive patients with left-sided IE undergoing surgery were investigated. During follow-up, neurological recovery was assessed using the modified Rankin scale and the Barthel index. Mortality was assessed with regression models adjusting for age. RESULTS The median follow-up time was 9.0 years. Patients with previous strokes were more likely to suffer from mitral valve endocarditis (29.5% vs 47.4%, P < 0.001). Symptomatic stroke was found in 135 (30.7%) patients; of them, 42 patients presented with complicated stroke (additional meningitis, haemorrhagic stroke or intracranial abscess). Driven by symptomatic stroke, the age-adjusted hospital mortality risk was 1.4-fold [95% confidence interval (CI) 0.74-2.57; P = 0.31] higher and the long-term mortality risk was 1.4-fold higher (95% CI 1.003-2.001; P = 0.048). Hospital mortality was higher in patients with complicated stroke (21.4% vs 9.7%; P = 0.06) only; however, mortality rates were similar comparing uncomplicated stroke versus no stroke. Among patients with complicated ischaemic strokes, the observed risk for intraoperative cerebral haemorrhage was 2.3% only and the increased hospital mortality was not driven by cerebral complications. In the long-term follow-up, full neurological recovery was observed in 84 out of 118 survivors (71.2%), and partial recovery was observed in 32 (27.1%) patients. Neurological recovery was lower in patients with complete middle cerebral artery stroke compared to other localization (52.9% vs 77.6%; P = 0.003). CONCLUSIONS Contrary to current clinical practice and neurological recommendations, early surgery in IE is safe and neurological recovery is excellent among patients with IE-related stroke. CLINICAL REGISTRATION NUMBER LOCAL IRB UN4232 382/3.1 (retrospective study).
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Affiliation(s)
- Elfriede Ruttmann
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Hannes Abfalterer
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Julian Wagner
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Ludwig Müller
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Katie Bates
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Hanno Ulmer
- Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
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11
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Fortes CQ, Fortes NRQ. Managing Patients with Infectious Endocarditis and Neurological Complication - The Big Dilemma that Persists Until these Days. Arq Bras Cardiol 2021; 116:692-694. [PMID: 33886712 PMCID: PMC8121385 DOI: 10.36660/abc.20210198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Claudio Querido Fortes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.,Faculdade de Medicina, Universidade Estácio de Sá, Rio de Janeiro, RJ - Brasil
| | - Natália Rodrigues Querido Fortes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ - Brasil.,Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Niterói, RJ - Brasil
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12
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Preoperative stroke before cardiac surgery does not increase risk of postoperative stroke. Sci Rep 2021; 11:9025. [PMID: 33907259 PMCID: PMC8079406 DOI: 10.1038/s41598-021-88441-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 04/05/2021] [Indexed: 01/04/2023] Open
Abstract
The optimal time when surgery can be safely performed after stroke is unknown. The purpose of this study was to investigate how cardiac surgery timing after stroke impacts postoperative outcomes between 2011–2017 were reviewed. Variables were extracted from the institutional Society of Thoracic Surgeons database, statewide patient registry, and medical records. Subjects were classified based upon presence of endocarditis and further grouped by timing of preoperative stroke relative to cardiac surgery: Recent (stroke within two weeks before surgery), Intermediate (between two and six weeks before), and Remote (greater than six weeks before). Postoperative outcomes were compared amongst groups. 157 patients were included: 54 in endocarditis and 103 in non-endocarditis, with 47 in Recent, 26 in Intermediate, and 84 in Remote. 30-day mortality and postoperative stroke rate were similar across the three subgroups for both endocarditis and non-endocarditis. Of patients with postoperative stroke, mortality was 30% (95% CI 4.6–66). Timing of cardiac surgery after stroke occurrence does not seem to affect postoperative stroke or mortality. If postoperative stroke does occur, subsequent stroke-related mortality is high.
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13
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Rice CJ, Kovi S, Wisco DR. Cerebrovascular Complication and Valve Surgery in Infective Endocarditis. Semin Neurol 2021; 41:437-446. [PMID: 33851397 DOI: 10.1055/s-0041-1726327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Infective endocarditis (IE) with neurologic complications is common in patients with active IE. The most common and feared neurological complication of left-sided IE is cerebrovascular, from septic emboli causing ischemic stroke, intracranial hemorrhage (ICH), or an infectious intracranial aneurysm with or without rupture. In patients with cerebrovascular complications, valve replacement surgery is often delayed for concern of further neurological worsening. However, in circumstances when an indication for valve surgery to treat IE is present, the benefits of early surgical treatment may outweigh the potential neurologic deterioration. Furthermore, valve surgery has been associated with lower in-hospital mortality than medical therapy with intravenous antibiotics alone. Early valve surgery can be performed within 7 days of transient ischemic attack or asymptomatic stroke when medically indicated. Timing of valve surgery for IE after symptomatic medium or large symptomatic ischemic stroke or ICH remains challenging, and current data in the literature are conflicting about the risks and benefits. A delay of 2 to 4 weeks from the time of the cerebrovascular event is often recommended, balancing the risks and benefits of surgery. The range of timing of valve surgery varies depending on the clinical scenario, and is best determined by a multidisciplinary decision between cardiothoracic surgeons, cardiologists, infectious disease experts, and vascular neurologists in an experienced referral center.
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Affiliation(s)
- Cory J Rice
- Erlanger Medical Center, University of Tennessee-Chattanooga College of Medicine, Chattanooga, Tennessee
| | - Shivakrishna Kovi
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dolora R Wisco
- Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Shih E, Squiers JJ, DiMaio JM. Systematic Review of Minimally Invasive Surgery for Mitral Valve Infective Endocarditis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:244-248. [PMID: 33829928 DOI: 10.1177/1556984521997086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The scope of application of minimally invasive mitral valve surgery is expanding. However, the safety and efficacy of minimally invasive mitral valve surgery in the setting of infective endocarditis is not well known. We sought to identify the best evidence available to support a minimally invasive surgical approach for mitral valve infective endocarditis. METHODS A systematic review of minimally invasive mitral valve surgery for infective endocarditis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 6 manuscripts describing 271 patients were identified. Mean age was 60.4 ± 14.9 years old, and 60.1% patients were male. Mean EuroSCORE II was 24.6 ± 23.2. Mitral valve repair was achieved in 32.4% of cases. The average in-hospital mortality was 9.4%, and average length of hospital stay was 21.6 days. Survival was 89.1% at 30 days, and 1-year survival was 79.3%. Rate of conversion to sternotomy was 1.8%. Postoperative complications included: 6.9% postoperative bleeding, 9.3% new postoperative dialysis, 2.3% postoperative stroke, and 3.4% recurrence of endocarditis. Reoperation over the long-term was required in 9.3% of cases. CONCLUSIONS Minimally invasive mitral valve surgery for infective endocarditis has acceptable perioperative morbidity as well as short- and intermediate-term mortality at experienced centers. Minimally invasive mitral valve surgery may be an acceptable alternative approach to infective endocarditis and warrants further study.
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Affiliation(s)
- Emily Shih
- 570470 Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano, Plano, TX, USA.,Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - John J Squiers
- 570470 Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano, Plano, TX, USA.,Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - J Michael DiMaio
- 570470 Baylor Scott & White Research Institute, The Heart Hospital Baylor Plano, Plano, TX, USA.,Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, TX, USA
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15
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Yokoyama Y, Goto T. Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis. J Cardiothorac Surg 2021; 16:49. [PMID: 33766081 PMCID: PMC7992857 DOI: 10.1186/s13019-021-01425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications. METHODS All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. RESULTS Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]] = 0.90 [0.49-1.64]; P = 0.10; I2 = 49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI] = 1.86 [0.76-4.52]; P = 0.43; I2 = 0%). CONCLUSIONS Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Taichiro Goto
- Department of General Thoracic Surgery, Yamanashi Central Hospital, Yamanashi, 400-8506, Japan.
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16
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Bonaros N, Czerny M, Pfausler B, Müller S, Bartel T, Thielmann M, Shehada SE, Folliguet T, Obadia JF, Holfeld J, Lorusso R, Parolari A, Müller L, Grimm M, Ruttmann-Ulmer E. Infective endocarditis and neurologic events: indications and timing for surgical interventions. Eur Heart J Suppl 2020; 22:M19-M25. [PMID: 33664636 PMCID: PMC7916418 DOI: 10.1093/eurheartj/suaa167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvana Müller
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bartel
- Department of Cardiology Mediclinic City, Hospital Dubai, Dubai, United Arab Emirates
| | - Matthias Thielmann
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Thierry Folliguet
- Department of Cardiac Surgery and Transplantation, Henry Mondor Hospital, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery and Transplantation, Louis Pradel Hospital, Lyon, France
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maaastricht, The Netherlands
| | | | - Ludwig Müller
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Elfriede Ruttmann-Ulmer
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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17
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Satriano UM, Nenna A, Spadaccio C, Pollari F, Fischlein T, Chello M, Nappi F. Guidelines on prosthetic heart valve management in infective endocarditis: a narrative review comparing American Heart Association/American College of Cardiology and European Society of Cardiology guidelines. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1625. [PMID: 33437824 PMCID: PMC7791243 DOI: 10.21037/atm-20-5134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Infective endocarditis (IE) represented over the last year a growing medical and surgical concern. The changes in etiology and demographic of the disease, which now includes also a large proportion of iatrogenic conditions, has prompted new studies and updates in the guideline for IE treatment. The increasing use of intravascular and intracardiac devices has introduced new challenges in terms of both antibiotic resistance and surgical treatment of prosthetic endocarditis. Also, patients with complex congenital heart diseases, intravenous drug abusers and patients with chronic renal failure under hemodialysis have been added to the list of high-risk subjects for IE. Important aspects concerning the establishment of the endocarditis team, the clinical management, the optimal medical therapy and the indication and timing for surgery are arguments of debate and controversy across the literature. In particular, the most adequate strategy to be adopted in the context of concomitant neurological complication remains greatly debated. Despite attempts to standardize the practice in IE, the lack of powered randomized clinical evidence prevented the achievement of a univocal consensus in several aspects of the management of IE. This situation reflects in some differences in the recommendation promoted by the European Society of Cardiology and American Heart Association/American College of Cardiology. In this review, we will compare the European Society of Cardiology and the American Heart Association guidelines and discuss important aspects related to clinical management and indications of for treatment.
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Affiliation(s)
| | - Antonio Nenna
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | | | - Massimo Chello
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
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18
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Diab M, Musleh R, Lehmann T, Sponholz C, Pletz MW, Franz M, Schulze PC, Witte OW, Kirchhof K, Doenst T, Günther A. Risk of postoperative neurological exacerbation in patients with infective endocarditis and intracranial haemorrhage. Eur J Cardiothorac Surg 2020; 59:ezaa347. [PMID: 33036027 DOI: 10.1093/ejcts/ezaa347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cardiac surgery in patients with infective endocarditis (IE) and preoperative intracranial haemorrhage (pre-ICH) is a highly debatable issue, and guidelines are still not well defined. The goal of this study was to investigate the effect of cardiac surgery and its timing on the clinical outcomes of patients with IE and pre-ICH. METHODS We did a single-centre retrospective analysis of data from patients with preoperative brain imaging who had surgery for left-sided IE between January 2007 and May 2018. RESULTS Among the 363 patients included in the study, 34 had pre-ICH. Hospital mortality was similar between the patients with and without pre-ICH (29% vs 27%, respectively; P = 0.84). Unadjusted, postoperative neurological deterioration appeared higher in patients with pre-ICH (24% vs 17%; P = 0.35). In multivariable analysis, pre-ICH did not qualify as an independent predictor for either postoperative neurological deterioration [odds ratio 1.10, 95% confidence interval (CI) 0.44-2.73; P = 0.84] or hospital mortality (odds ratio 1.02, 95% CI 0.43-2.40; P = 0.96). Postoperative partial thromboplastin time was significantly elevated in 4 patients with relevant post-ICH compared with those patients without relevant post-ICH (65.5 vs 37.6, respectively; P = 0.004). CONCLUSIONS Pre-ICH was not an independent predictor for postoperative neurological deterioration or hospital mortality in patients with IE. Postoperative coagulation management seems to be crucial in patients with IE with ICH. Although this is to date the largest monocentric study addressing surgical decision and timing, the number of patients with pre-ICH was low. Therefore, these conclusions should be regarded with caution; randomized clinical trials are needed.
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Affiliation(s)
- Mahmoud Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Rita Musleh
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Marcus Franz
- Division of Cardiology, Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - P Christian Schulze
- Division of Cardiology, Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Klaus Kirchhof
- Division of Neuroradiology, Department of Radiology, Jena University Hospital, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - Albrecht Günther
- Department of Neurology, Jena University Hospital, Jena, Germany
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19
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Scheggi V, Alterini B, Olivotto I, Del Pace S, Zoppetti N, Tomberli B, Bartalesi F, Brandi L, Ceschia N, Andrei V, Suardi LR, Marchionni N, Stefàno PL. Embolic risk stratification and prognostic impact of early surgery in left-sided infective endocarditis. Eur J Intern Med 2020; 78:82-87. [PMID: 32317239 DOI: 10.1016/j.ejim.2020.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/13/2020] [Accepted: 04/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND In patients with left-sided infective endocarditis (IE) and heart failure associated with large vegetations, early surgery prevents embolic events. However, optimal timing of surgery for other indications is still unresolved particularly when the presence of large vegetations represents the sole indication. METHODS We retrospectively analyzed 308 consecutive patients admitted to our department with definite left-sided IE. Of these patients, 243 (79%) underwent cardiac surgery (complicated IE), 34 patients with uncomplicated IE received medical treatment, 24 were not operated due to prohibitive general conditions and 7 refused surgery. Long-term follow-up was obtained by structured telephone interviews. RESULTS During the 6-year follow-up (average 121.8 weeks ± 76), patients not operated because of general conditions or refusal had the worst prognosis, while outcome in operated patients for complicated IE was comparable to that of uncomplicated IE treated medically. Early (<2 weeks from diagnosis) surgery was associated with better survival compared to delayed surgery (HR 0.58, p = 0.23). Embolic events were detected at admission in 38% of cases; Staphylococcus Aureus etiology and vegetation size were independently associated with embolism (OR 2.4, p = 0.01; OR 1, p=0.008 respectively). CONCLUSIONS Compared to uncomplicated medically-treated patients, complicated IE showed comparable survival when managed aggressively by surgical intervention, whereas a conservative approach was associated with an adverse prognosis. Staphylococcus Aureus infection and vegetation size were independent predictors of systemic embolism. Our data support aggressive surgical management of complicated IE patients and highlight the importance of etiological characterization in clinical decision-making.
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20
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Kousa O, Walters RW, Saleh M, Awad D, Qasim A, Guddeti RR, Smer A. Early vs late cardiac surgery in patients with native valve endocarditis-United States Nationwide Inpatient database. J Card Surg 2020; 35:2611-2617. [PMID: 32720363 DOI: 10.1111/jocs.14854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although the standard treatment of infective endocarditis (IE) is antimicrobial therapy, surgical intervention is required in some cases. However, the optimal timing of surgery remains unclear. Hence, we conducted a population-based analysis using the National Inpatient Sample (NIS) database to assess the outcomes of early versus late surgery in patients with native valve IE. METHODS We queried the NIS database for all hospitalized patients between 2006 and 2016 with a primary diagnosis of IE who had cardiac surgery. We stratified surgery as early ≤7 or late >7 days of admission. Multivariable logistic regression models were used to assess in-hospital mortality and postoperative complications. Length of stay (LOS) and total hospital cost (HC) were evaluated using multivariable log-normal regression models. RESULTS A total of 13 056 patients (57.6% in the early group and 42.4% in the late group) were included. The in-hospital mortality rate in the early group was 5.0% compared to 5.4% in the late intervention group (adjusted odds ratio, 1.20, 95% confidence interval [CI] 0.79-1.81). Overall median LOS was reduced in the early group by 48.2% (95% CI, 46.5%-49.9%, 12.4 days in the early group and 25.9 days in late group), as well as HC which was reduced in the early group by 28.3% (95% CI, 26.0%-30.6%). CONCLUSION Among patients with native valve IE who needed cardiac surgery, the time of surgical intervention did not affect the in-hospital mortality. However, early surgery was associated with significantly shorter LOS and lower HC.
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Affiliation(s)
- Omar Kousa
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Ryan W Walters
- Division of Clinical Research and Evaluation Science, Creighton University School of Medicine, Omaha, Nebraska
| | - Mohammed Saleh
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Dana Awad
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Abdallah Qasim
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Raviteja R Guddeti
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Aiman Smer
- Department of Cardiovascular Medicine, Creighton University School of Medicine, Omaha, Nebraska
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21
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Venn RA, Ning M, Vlahakes GJ, Wasfy JH. Surgical timing in infective endocarditis complicated by intracranial hemorrhage. Am Heart J 2019; 216:102-112. [PMID: 31422194 DOI: 10.1016/j.ahj.2019.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 07/13/2019] [Indexed: 12/24/2022]
Abstract
Given the growing incidence of infective endocarditis (IE), understanding the risks and benefits of valvular surgery is critical. This decision is particularly complex for the 1 in 10 cases complicated by intracranial hemorrhage (ICH). While guideline recommendations currently favor early surgery in general, delayed intervention of at least 4 weeks is still recommended for patients with ICH. To date, there are no randomized controlled trials that inform management of patients with an indication for surgery but concomitant ICH, and even reported observational data are rare. This paper reviews the current literature on timing of surgery with a specific focus on cases of ICH. It emphasizes a growing body of literature challenging the current paradigm that surgery within 4 weeks is associated with neurologic deterioration and high mortality rates by demonstrating favorable outcomes for patients with pre-operative ICH who undergo early valvular surgery. Based on these data, we propose a practical management algorithm to facilitate decisions on surgical timing in these complicated cases. Since more rigorous evidence may never be available, clinicians should make patient-specific surgical timing decisions that attempt to balance the competing risks of neurologic versus cardiac complications.
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Affiliation(s)
- Rachael A Venn
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - MingMing Ning
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gus J Vlahakes
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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22
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[Treatment of infectious endocarditis]. Presse Med 2019; 48:539-548. [PMID: 31109766 DOI: 10.1016/j.lpm.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/07/2019] [Accepted: 04/21/2019] [Indexed: 11/21/2022] Open
Abstract
Antibiotic treatment of infective endocarditis is part of a multidisciplinary patient management that should be conducted within an "Endocarditis team". Initial antibiotic treatment of infective endocarditis should be parenteral and comply with current international guidelines. A switch to an oral antibiotic regimen may be considered after 2weeks of successful parenteral antibiotic treatment. Aminoglycosides should no longer be used for the initial treatment of native valve Staphylococcus aureus endocarditis. Valve surgery is required in almost half of the patients.
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23
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Sotero FD, Rosário M, Fonseca AC, Ferro JM. Neurological Complications of Infective Endocarditis. Curr Neurol Neurosci Rep 2019; 19:23. [PMID: 30927133 DOI: 10.1007/s11910-019-0935-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review and update is to summarize the current knowledge and provide recent advances on the neurologic complications of infective endocarditis. RECENT FINDINGS Neurological complications occur in about one-fourth of patients with infective endocarditis. Brain MRI represents a major tool for the identification of asymptomatic lesions, which occur in most of the patients with infective endocarditis. The usefulness of systematic brain imaging and the preferred treatment of patients with infective endocarditis and silent brain lesions remains uncertain. The basis of treatment of infective endocarditis is early antimicrobial therapy. In stroke due to infective endocarditis, anticoagulation and thrombolysis should be avoided. Endovascular treatment can be useful for both acute septic emboli and mycotic aneurysms, but evidence is still limited. In patients with neurological complications, cardiac surgery can be safely performed early, if indicated. The optimal management of a patients with neurological complications of infective endocarditis needs an individualized case discussion and the participation of a multidisciplinary team including neurologists, cardiologists, cardiothoracic surgeons, neuroradiologists, neurosurgeons, and infectious disease specialists.
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Affiliation(s)
- Filipa Dourado Sotero
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Madalena Rosário
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Neurology 6th floor, Avenida Professor Egas Moniz s/n, 1649-035, Lisbon, Portugal
| | - José M Ferro
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal. .,Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Neurology 6th floor, Avenida Professor Egas Moniz s/n, 1649-035, Lisbon, Portugal.
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24
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Chan V. When Should Infective Endocarditis Be Treated With Early Surgical Intervention? Can J Cardiol 2018; 34:1110-1111. [PMID: 30078694 DOI: 10.1016/j.cjca.2018.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
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