Yoshioka Daisuke, Toda Koichi, Okazaki Shuhei, Sakaguchi Taichi, Miyagawa Shigeru, Yoshikawa Yasushi, Sawa Yoshiki
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Ann Thorac Surg. 2015 Jul;100(1):16-23. doi: 10.1016/j.athoracsur.2015.02.056. Epub 2015 May 13.
Infective endocarditis is often associated with cerebral complications, the most serious of which is intraoperative hemorrhagic stroke owing to anticoagulation for cardiopulmonary bypass. However, its prevalence and risk factors are unknown. We evaluated the prevalence and risk factors of intraoperative hemorrhagic stroke in patients with infective endocarditis.
In 246 patients who underwent valve surgery for active endocarditis between 2005 and 2012, 127 patients had both preoperative and postoperative intracranial neuroimaging. The prevalence and risk factors of intraoperative stroke were analyzed in those 127 patients.
Valve surgery was performed in 127 patients 19.6 ± 27.1 days after infective endocarditis diagnosis. Fourteen experienced intraoperative hemorrhagic stroke, and 1 died. None of 29 patients with preoperative hemorrhagic stroke showed exacerbation of hemorrhagic lesions, whereas 1 of 57 patients with preoperative cerebral infarction showed hemorrhagic transformation of infarct lesions. Thirteen of 14 hemorrhagic complications were new ectopic intracranial hemorrhage. Multivariate analysis showed not preoperative cerebral lesions but preoperative low hemoglobin level as the only risk factor for intraoperative hemorrhagic stroke (odds ratio, 0.51; 95% confidence interval, 0.26 to 0.87; p = 0.03). A preoperative hemoglobin cutoff value of 9.2 g/dL was determined by receiver operating curve analysis. Of 41 patients with preoperative hemoglobin level less than 9.2 g/dL, 9 (22%) had intraoperative new hemorrhage, whereas 4 (5%) of 86 patients with hemoglobin level of at least 9.2 g/dL had ectopic new hemorrhage.
Intraoperative hemorrhagic stroke was not rare, and ectopic hemorrhagic stroke, associated with preoperative anemia, was more prevalent than hemorrhagic transformation of existing cerebral lesions.
感染性心内膜炎常伴有脑部并发症，其中最严重的是体外循环抗凝导致的术中出血性卒中。然而，其发生率及危险因素尚不清楚。我们评估了感染性心内膜炎患者术中出血性卒中的发生率及危险因素。
2005年至2012年间，246例因活动性心内膜炎接受瓣膜手术的患者中，127例患者术前行颅内神经影像学检查，术后再次检查。分析这127例患者术中卒中的发生率及危险因素。
感染性心内膜炎诊断后19.6±27.1天，对127例患者实施了瓣膜手术。14例发生术中出血性卒中，1例死亡。29例术前有出血性卒中的患者，其出血性病变均未加重，而57例术前有脑梗死的患者中，1例梗死灶发生出血转化。14例出血并发症中，13例为新发性颅内异位出血。多因素分析显示，术前脑病变不是术中出血性卒中的危险因素，而术前低血红蛋白水平是唯一的危险因素（比值比，0.51；95%置信区间，0.26至0.87；P = 0.03）。通过受试者工作特征曲线分析确定术前血红蛋白临界值为9.2 g/dL。术前血红蛋白水平低于9.2 g/dL的41例患者中，9例（22%）术中出现新出血，而血红蛋白水平至少为9.2 g/dL的86例患者中，4例（5%）出现异位新出血。
术中出血性卒中并不罕见，与术前贫血相关的异位出血性卒中比现有脑病变的出血转化更为常见。
