Yutaka Okita1, Kenji Minakata2, Shinji Yasuno3, Ryuji Uozumi2, Tosiya Sato4, Kenji Ueshima3, Hiroaki Konishi5, Naomi Morita6, Masafumi Harada7, Junjiro Kobayashi6, Shigefumi Suehiro8, Koji Kawahito9, Hitoshi Okabayashi10, Shuichiro Takanashi11, Yuichi Ueda12, Akihiko Usui13, Kiyotaka Imoto14, Hiroyuki Tanaka15, Yoshitaka Okamura16, Ryuzo Sakata17, Hitoshi Yaku18, Kazuo Tanemoto19, Yutaka Imoto20, Kazuhiro Hashimoto21, Ko Bando21. 1. Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan yokita@med.kobe-u.ac.jp. 2. Kyoto University Graduate School of Medicine, Kyoto, Japan. 3. Kyoto University Hospital, Kyoto, Japan. 4. Kyoto University School of Public Health, Kyoto, Japan. 5. Konishi Cardio-Vascular Medical Clinic, Shimonoseki, Japan. 6. National Cerebral and Cardiovascular Center, Osaka, Japan. 7. University of Tokushima, Tokushima, Japan. 8. Osaka City University Graduate School of Medicine, Osaka, Japan. 9. Jichi Medical University, Shimotsuke, Japan. 10. Iwate Medical University, Morioka, Japan. 11. Sakakibara Heart Institute, Okayama, Japan. 12. Nara Prefecture General Medical Center, Nara, Japan. 13. Nagoya University Graduate School of Medicine, Nagoya, Japan. 14. Yokohama City University Medical Center, Yokohama, Japan. 15. Kurume University School of Medicine, Kurume, Japan. 16. Wakayama Medical University, Wakayama, Japan. 17. Kobe City Medical Center General Hospital, Kobe, Japan. 18. Kyoto Prefectural University of Medicine, Kyoto, Japan. 19. Kawasaki Medical School, Kurashiki, Japan. 20. Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 21. Jikei University School of Medicine, Tokyo, Japan.
Abstract
OBJECTIVES: The aim of this study was to investigate the effect of the timing of valve surgery on the clinical outcomes of patients with active infective endocarditis (IE) accompanied by cerebral complications. METHODS: We retrospectively analysed a cohort of 568 patients, comprising 118 with non-haemorrhagic cerebral infarction (CI), 54 with intracranial haemorrhage (ICH) and 396 without cerebral events (C; control), who underwent surgery for left-sided active IE in 15 Japanese institutes from 2000 to 2011. The mean age was 58.4 ± 16.9 years in the CI group; 54.5 ± 17.4 years in the ICH group and 56.9 ± 16.0 years in the C group. Clinical outcomes were analysed according to the timing of surgery after the diagnosis of CI or ICH was made. RESULTS: In the CI group, there were 9 (7.6%) hospital deaths, 13 (11%) new cerebral events and 1 (0.8%) redo valve surgery. In the ICH group, there were 3 (5.6%) hospital deaths, 8 (14.8%) new cerebral events and 2 (3.7%) redo valve surgeries. In the C group, there were 36 (9.1%) hospital deaths, 23 (5.8%) new cerebral events and 9 (2.3%) redo valve surgeries. Risk factors for hospital death were prosthetic valve endocarditis (P = 0.045), high C-reactive protein (CRP; P < 0.001) and the elderly (P < 0.001) in the CI group. Delayed surgery (2 weeks after CI) seemed result in a higher incidence of hospital death in the CI group. Patients who had surgery between 15 and 28 days or after 29 days from the onset of CI had higher incidences of hospital death [odds ratio 5.90 (P = 0.107) and 4.92 (P = 0.137), respectively] compared with those who had surgery within 7 days. In the ICH group, risk factors for hospital death were high CRP (P = 0.002) and elderly (P < 0.001). Contrary to CI patients, patients who had surgery between 8 and 21 days or after 22 days after the onset of ICH had lower incidences of hospital death [odds ratio 0.79 (P = 0.843) and 0.12 (P = 0.200), respectively] compared with those who had surgery within 7 days. CONCLUSIONS: Although statistically insignificant, early surgery in active IE patients with CI is safe, but very early surgery (within 7 days) should be avoided in patients with ICH.
OBJECTIVES: The aim of this study was to investigate the effect of the timing of valve surgery on the clinical outcomes of patients with active infective endocarditis (IE) accompanied by cerebral complications. METHODS: We retrospectively analysed a cohort of 568 patients, comprising 118 with non-haemorrhagic cerebral infarction (CI), 54 with intracranial haemorrhage (ICH) and 396 without cerebral events (C; control), who underwent surgery for left-sided active IE in 15 Japanese institutes from 2000 to 2011. The mean age was 58.4 ± 16.9 years in the CI group; 54.5 ± 17.4 years in the ICH group and 56.9 ± 16.0 years in the C group. Clinical outcomes were analysed according to the timing of surgery after the diagnosis of CI or ICH was made. RESULTS: In the CI group, there were 9 (7.6%) hospital deaths, 13 (11%) new cerebral events and 1 (0.8%) redo valve surgery. In the ICH group, there were 3 (5.6%) hospital deaths, 8 (14.8%) new cerebral events and 2 (3.7%) redo valve surgeries. In the C group, there were 36 (9.1%) hospital deaths, 23 (5.8%) new cerebral events and 9 (2.3%) redo valve surgeries. Risk factors for hospital death were prosthetic valve endocarditis (P = 0.045), high C-reactive protein (CRP; P < 0.001) and the elderly (P < 0.001) in the CI group. Delayed surgery (2 weeks after CI) seemed result in a higher incidence of hospital death in the CI group. Patients who had surgery between 15 and 28 days or after 29 days from the onset of CI had higher incidences of hospital death [odds ratio 5.90 (P = 0.107) and 4.92 (P = 0.137), respectively] compared with those who had surgery within 7 days. In the ICH group, risk factors for hospital death were high CRP (P = 0.002) and elderly (P < 0.001). Contrary to CI patients, patients who had surgery between 8 and 21 days or after 22 days after the onset of ICH had lower incidences of hospital death [odds ratio 0.79 (P = 0.843) and 0.12 (P = 0.200), respectively] compared with those who had surgery within 7 days. CONCLUSIONS: Although statistically insignificant, early surgery in active IE patients with CI is safe, but very early surgery (within 7 days) should be avoided in patients with ICH.