Department of Cardiac Surgery, Aichi Medical University Hospital, 1-1 Yazako Karimata, Nagakute, 480-1195, Aichi, Japan.
J Cardiothorac Surg. 2024 Apr 20;19(1):254. doi: 10.1186/s13019-024-02768-x.
The treatment of patients with infective endocarditis (IE) who have preoperative cerebral complications remains less understood. Therefore, this study aimed to retrospectively evaluate the clinical outcomes of patients with acute IE based on preoperative intracranial findings.
Of 32 patients with acute IE treated at our hospital between August 2015 and March 2022, 31 patients of whom preoperative intracranial imaging evaluation was available were included in our analysis and compared with those with and without intracranial findings. We controlled the mean arterial blood pressure and activated clotting time (ACT) to prevent abnormally high perfusion pressures and ACTs during cardiopulmonary bypass (CPB). The preoperative background, and postoperative courses focusing on postoperative brain complications were reviewed.
Among the 31 patients, 20 (65%) had preoperative imaging findings. The group with intracranial findings was significantly older, with more embolisms in other organs, positive intraoperative pathology findings, and longer CPB times. A new cerebral hemorrhage developed postoperatively in one patient without intracranial findings. There were no early deaths; two patients had recurrent infections in each group, and one died because of sepsis in the late phase in the group with intracranial findings.
Positive intracranial findings indicated significantly active infectious conditions preoperatively but did not affect the postoperative course. Patients without preoperative cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of preoperative cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without intracranial findings.
术前合并颅内并发症的感染性心内膜炎（IE）患者的治疗仍不太清楚。因此，本研究旨在回顾性评估基于术前颅内发现的急性 IE 患者的临床结局。
在我院 2015 年 8 月至 2022 年 3 月期间治疗的 32 例急性 IE 患者中，对 31 例术前颅内影像学评估可用的患者进行了分析，并与有和无颅内发现的患者进行了比较。我们控制平均动脉压和激活凝血时间（ACT），以防止体外循环（CPB）期间出现异常高的灌注压和 ACT。回顾了术前背景和术后重点关注术后脑并发症的过程。
在 31 例患者中，有 20 例（65%）术前有影像学发现。有颅内发现的组年龄明显更大，有其他器官的栓塞、术中病理发现阳性和更长的 CPB 时间。1 例无颅内发现的患者术后新发脑出血。无早期死亡；两组各有 1 例患者复发感染，有颅内发现的组有 1 例患者因晚期败血症死亡。
术前颅内发现表明存在明显活跃的感染情况，但不影响术后病程。无术前脑并发症的患者可发生严重脑出血。虽然对所有 IE 患者进行术前脑并发症的仔细检查至关重要，但应采取策略预防脑出血，即使在无颅内发现的患者中也是如此。
