Valve replacement in patients with endocarditis and acute neurologic deficit

Gillinov, A. Marc; Shah, Rinoo V.; Curtis, William E.; Stuart, R. Scott; Cameron, Duke E.; Baumgartner, William A.; Greene, Peter S.

doi:10.1016/0003-4975(96)00014-8

Cited by 165 publications

(99 citation statements)

References 18 publications

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“…8) Historically, the recommendation has been to avoid surgery during the active phase, when inflamed, infected tissues make surgery very difficult and lead to high postoperative mortality rates and a greatly elevated risk of valve dysfunction. 14) This belief has changed dramatically over the past two decades with improvements in surgical technique.…”

Section: Discussionmentioning

confidence: 99%

“…CT should be the first diagnostic test for evaluating patients with IE and neurological deficits, as a large proportion of patients with nonhemorrhagic cerebral infarction are asymptomatic. 8) Further examinations by MRA should be performed to detect mycotic aneurysm when there is cerebrovascular lesion on CT. The clinical presentation of patients with intracranial mycotic aneurysm is highly variable.…”

Section: Discussionmentioning

confidence: 99%

“…7) Various studies have investigated operative outcomes among IE patients with cerebrovascular complications and have suggested management plans for such patients. [8][9][10][11] However, these suggested plans are unclear and are difficult to apply to patients with multiple cerebrovascular complications. Prospective randomized assessments of the proposed plans have also been lacking.…”

Section: Management Of Infective Endocarditis With Cerebral Complicatmentioning

confidence: 99%

“…They recommend waiting 4 weeks after cerebral infarction, where the exacerbation rate of neurological complication is the lowest (2.3%). Gillinov, et al 8) suggested delaying cardiac operations 2 to 3 weeks in patients with non-hemorrhagic embolic cerebrovascular accident. In a systematic review of the literature, Angstwurm,et al 11) demonstrated that the risk of neurological deterioration was 0.4% after 4 weeks.…”

Section: Fig 1 Enhanced Cranial Computed Tomography (Ct) and Ct Angimentioning

confidence: 99%

“…They concluded that there is some risk of progression of cerebral damage at 15 days and even 4 weeks after the hemorrhage, regardless of the timing of the operation. Gillinov, et al 8) operated on 4 patients with embolic cerebrovascular accident and hemorrhage at an average of 27.2 ± 11.6 days from the time of cerebral hemorrhage. They encountered no deaths or new neurological deficits, and recommended an interval of 4 weeks between the neurological event and cardiac operation.…”

Section: Fig 1 Enhanced Cranial Computed Tomography (Ct) and Ct Angimentioning

confidence: 99%

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Management of Infective Endocarditis with Cerebral Complications

Fukuda¹,

Daitoku²,

Minakawa³

et al. 2014

ATCS

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Purpose: Management of patients with infective endocarditis complicated by neurological deficits is challenging. No clear management guidelines have been defined, and the timing of surgery remains controversial. The purpose of this study was to evaluate our management algorithm. Methods: Thirty-eight adult patients with left-sided infective endocarditis undergoing valve surgery were analyzed. Before the operation, enhanced brain computed tomography (CT) was performed to rule out a cerebral complication. Pre and postoperative data were retrospectively reviewed to clarify whether our algorithm was effective. Sixteen patients having neurological complication (CVC group) were compared with 22 patients without neurological complication. Results: Age, sex, New York Heart Association (NYHA) functional class, affected valve and pathogens were not different between two groups. Mean interval from the onset of neurological dysfunction to cardiac operation was 27.8 ± 27.8 days (median 23 days). Of the 16 CVC group patients, 12 experienced cerebral infarction. Mass effects were seen in 3 patients, with 1 of these 3 patients died following aneurysm rupture. Mycotic aneurysm was detected in 4 patients, with 3 undergoing successful staged operations. Mortality and postoperative neurological exacerbation in CVC group was 6.3% (1 patient). Most patients who fulfilled the algorithm showed good outcomes. Conclusions: Our suggested management algorithm for infective endocarditis appears effective.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%