Diab Mahmoud, Musleh Rita, Lehmann Thomas, Sponholz Christoph, Pletz Mathias W, Franz Marcus, Schulze P Christian, Witte Otto W, Kirchhof Klaus, Doenst Torsten, Günther Albrecht
Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany.
Department of Neurology, Jena University Hospital, Jena, Germany.
Eur J Cardiothorac Surg. 2020 Oct 9. doi: 10.1093/ejcts/ezaa347.
Cardiac surgery in patients with infective endocarditis (IE) and preoperative intracranial haemorrhage (pre-ICH) is a highly debatable issue, and guidelines are still not well defined. The goal of this study was to investigate the effect of cardiac surgery and its timing on the clinical outcomes of patients with IE and pre-ICH.
We did a single-centre retrospective analysis of data from patients with preoperative brain imaging who had surgery for left-sided IE between January 2007 and May 2018.
Among the 363 patients included in the study, 34 had pre-ICH. Hospital mortality was similar between the patients with and without pre-ICH (29% vs 27%, respectively; P = 0.84). Unadjusted, postoperative neurological deterioration appeared higher in patients with pre-ICH (24% vs 17%; P = 0.35). In multivariable analysis, pre-ICH did not qualify as an independent predictor for either postoperative neurological deterioration [odds ratio 1.10, 95% confidence interval (CI) 0.44-2.73; P = 0.84] or hospital mortality (odds ratio 1.02, 95% CI 0.43-2.40; P = 0.96). Postoperative partial thromboplastin time was significantly elevated in 4 patients with relevant post-ICH compared with those patients without relevant post-ICH (65.5 vs 37.6, respectively; P = 0.004).
Pre-ICH was not an independent predictor for postoperative neurological deterioration or hospital mortality in patients with IE. Postoperative coagulation management seems to be crucial in patients with IE with ICH. Although this is to date the largest monocentric study addressing surgical decision and timing, the number of patients with pre-ICH was low. Therefore, these conclusions should be regarded with caution; randomized clinical trials are needed.
感染性心内膜炎（IE）合并术前颅内出血（pre-ICH）患者的心脏手术是一个极具争议的问题，相关指南仍未明确界定。本研究的目的是探讨心脏手术及其时机对IE合并pre-ICH患者临床结局的影响。
我们对2007年1月至2018年5月期间因左侧IE接受手术且术前行脑部影像学检查的患者数据进行了单中心回顾性分析。
在纳入研究的363例患者中，34例有pre-ICH。有和没有pre-ICH的患者医院死亡率相似（分别为29%和27%；P = 0.84）。未经调整时，pre-ICH患者术后神经功能恶化似乎更高（24%对17%；P = 0.35）。在多变量分析中，pre-ICH既不符合术后神经功能恶化的独立预测因素[比值比1.10，95%置信区间（CI）0.44 - 2.73；P = 0.84]，也不符合医院死亡率的独立预测因素（比值比1.02，95% CI 0.43 - 2.40；P = 0.96）。与无相关ICH后情况的患者相比，4例有相关ICH后情况的患者术后部分凝血活酶时间显著延长（分别为65.5对37.6；P = 0.004）。
Pre-ICH不是IE患者术后神经功能恶化或医院死亡率的独立预测因素。术后凝血管理对合并ICH的IE患者似乎至关重要。尽管这是迄今为止针对手术决策和时机的最大规模单中心研究，但pre-ICH患者数量较少。因此，这些结论应谨慎看待；需要进行随机临床试验。
