Early and mid-term outcomes following surgical management of infective endocarditis with associated cerebral complications: a single centre experience

Yeates, Alexander, Mundy, Julie, Griffin, Rayleene, Marshall, Lachlan, Wood, Annabelle, Peters, Paul and Shah, Pallav (2010) Early and mid-term outcomes following surgical management of infective endocarditis with associated cerebral complications: a single centre experience. Heart Lung and Circulation, 19 9: 523-527. doi:10.1016/j.hlc.2010.03.004


Author Yeates, Alexander
Mundy, Julie
Griffin, Rayleene
Marshall, Lachlan
Wood, Annabelle
Peters, Paul
Shah, Pallav
Title Early and mid-term outcomes following surgical management of infective endocarditis with associated cerebral complications: a single centre experience
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
1444-2892
Publication date 2010-09
Year available 2010
Sub-type Article (original research)
DOI 10.1016/j.hlc.2010.03.004
Volume 19
Issue 9
Start page 523
End page 527
Total pages 5
Place of publication Chatswood, NSW, Australia
Publisher Elsevier Australia
Language eng
Formatted abstract
Background: Surgical management of patients with infective endocarditis (IE) who have suffered preoperative cerebrovascular complications remains controversial. This study evaluates the impact of timing from stroke to valvular surgery on the early and mid-term neurological sequelae, functional status and quality of life in this high-risk group of patients with IE. Method: Data on 13/108 (12%) patients with IE who suffered cerebrovascular complications during the period 1998-2009 was prospectively collected. Mean follow-up was 37.2 months (100% complete). Results: Three of 13 (23%) suffered haemorrhagic stroke, 10/13 (77%) had embolic events (nine, stroke; one, TIA). The clinical diagnosis was made by a neurologist in 6/13 (46%) and confirmed in all by CT scan. Twelve of 13 had motor deficit involving MCA territory. Thirty-day mortality was 2/13 (one, cardiac; one, neurological) with no late deaths. The mean time from embolic stroke to surgery was 2.3 weeks (range 3-60 days). The reason for operating on eight patients in less than two weeks was heart failure in five, uncontrolled sepsis, AMI and TIA (one each). 2/8 (25%) suffered additional postoperative neurological events (one, brain death, one, new MCA stroke). On follow-up of the remaining eight patients with embolic events, five had improved neurology and three had stable neurology. The mean time to surgery from haemorrhagic stroke was 5.8 weeks (range 3-60 days). Deficit improved in two patients (<1 week, 1; >8 weeks, 1). On follow-up the NYHA class was I-II in 6/11 (56%). The EQ-5D questionnaire was used to assess quality of life. Mean index for the group was 0.67 using the US preference-weighted index score (SD 0.27). Conclusions: Results regarding timing for haemorrhagic stroke cannot be defined from the small numbers. Timely surgical intervention (embolic greater than two weeks and preferably four weeks in absence of heart failure) is associated with acceptable neurological outcome, functional class and quality of life. © 2010.
Keyword Infective endocarditis
Cerebrovascular complications
Surgical management
Neurologic Complications
Valve-Replacement
Deficit
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Faculty of Health and Behavioural Sciences -- Publications
 
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