Kim Do Yeon, Kim Hwan Wook, Jo Keon Hyon
Department of Thoracic & Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Interact Cardiovasc Thorac Surg. 2017 Apr 1;24(4):521-526. doi: 10.1093/icvts/ivw382.
This study followed the results of any development of neurologic outcomes according to the presence or absence of cerebral stroke in infective endocarditis patients after early cardiac surgery. We also analysed the neurologic outcomes regardless of cerebral microbleeds in cerebral embolic patients after cardiac surgery.
We retrospectively studied 55 patients with left-sided infective endocarditis who underwent early surgery and hospitalization between May 2010 and May 2015. Preoperatively, there were 33 patients in the cerebral embolic group and 22 patients in the non-embolic event group. Among the cerebral embolic patients, 13 patients had additional cerebral microbleeds on brain imaging.
After cardiac surgery, intracranial haemorrhage and haemorrhagic complications occurred in 2 patients (9.1%) in the non-embolic group and 5 patients (15.1%) in the embolic group. There was no statistically significant difference in postoperative neurologic problems between the non-embolic group and the embolic group (22.7% vs 30.3%, respectively, P = 0.54). Early mortality was 4.5% in the non-embolic group and 9.1% in the embolic group ( P = 1.00). In the cerebral microbleeds combined with septic embolism group, the neurologic problem rate (38.5%) was higher than in the non-cerebral microbleeds group (20.0%), but the difference was not statistically significant.
Our analysis showed that the rate of postoperative neurologic problems was not high in patients with cerebral septic embolism. Despite this, early surgery is not contraindicated in cerebral septic emboli patients. Cerebral microbleeds related to septic embolism were suspected to increase the rate of neurologic problems after cardiac surgery. So, further studies are needed to assess about the influence of cerebral microbleeds in cardiac operation.
本研究追踪了感染性心内膜炎患者早期心脏手术后发生脑卒中和未发生脑卒中时神经功能结局的任何发展结果。我们还分析了心脏手术后脑栓塞患者无论有无脑微出血的神经功能结局。
我们回顾性研究了2010年5月至2015年5月期间接受早期手术并住院的55例左侧感染性心内膜炎患者。术前，脑栓塞组有33例患者，非栓塞事件组有22例患者。在脑栓塞患者中，13例患者在脑部影像学检查中有额外的脑微出血。
心脏手术后，非栓塞组有2例患者（9.1%）发生颅内出血和出血性并发症，栓塞组有5例患者（15.1%）发生。非栓塞组和栓塞组术后神经问题无统计学显著差异（分别为22.7%和30.3%，P = 0.54）。非栓塞组早期死亡率为4.5%，栓塞组为9.1%（P = 1.00）。在脑微出血合并脓毒性栓塞组中，神经问题发生率（38.5%）高于无脑微出血组（20.0%），但差异无统计学意义。
我们的分析表明，脑脓毒性栓塞患者术后神经问题发生率不高。尽管如此，早期手术在脑脓毒性栓塞患者中并非禁忌。怀疑与脓毒性栓塞相关的脑微出血会增加心脏手术后神经问题的发生率。因此，需要进一步研究来评估脑微出血在心脏手术中的影响。
