Hasegawa Shota, Takahashi Hiroaki, Yamanaka Katsuhiro, Okada Kenji
Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 2-5-7, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Surg Today. 2025 Jun;55(6):795-802. doi: 10.1007/s00595-024-02964-1. Epub 2024 Nov 27.
Early surgery for infective endocarditis with intracranial hemorrhage can cause severe bleeding, which is correlated with an increased mortality. In 2005, we started using nafamostat mesilate and low-dose heparin as anticoagulants during cardiopulmonary bypass for early surgery. The outcomes of this strategy have been reviewed.
All patients who underwent cardiac surgery for active infective endocarditis with intracranial hemorrhage between 2005 and 2023 were evaluated.
There were 23 consecutive patients (median age 62 years old). Ten patients (43%) had neurologic deficits. The indication for early surgery in most patients was the presence of mobile vegetation or existing embolic events (18 of 23, 78%). No complications were associated with cardiopulmonary bypass. The median interval between the diagnosis and surgery was two days. There was 1 early death (4%) due to sepsis. There was no exacerbation of intracranial hemorrhage. One patient had new ectopic microbleeds without deterioration of neurologic findings. One patient had a new-onset cerebral infarction with neurologic deficits. None of the patients exhibited neurologic deterioration. The median follow-up duration was 26 months. overall survival was 90.7% after 5 years.
Our strategy of using nafamostat mesilate enabled us to safely perform early surgery in patients with intracranial hemorrhage without hemorrhage exacerbation.
感染性心内膜炎合并颅内出血患者早期手术可能导致严重出血，这与死亡率增加相关。2005年，我们开始在体外循环期间使用甲磺酸萘莫司他和低剂量肝素作为抗凝剂进行早期手术。现对该策略的结果进行回顾。
对2005年至2023年间因活动性感染性心内膜炎合并颅内出血而接受心脏手术的所有患者进行评估。
连续纳入23例患者（中位年龄62岁）。10例患者（43%）存在神经功能缺损。大多数患者早期手术的指征是存在活动的赘生物或现有的栓塞事件（23例中的18例，78%）。未发生与体外循环相关的并发症。诊断与手术之间的中位间隔时间为2天。有1例（4%）患者因脓毒症早期死亡。颅内出血未加重。1例患者出现新的异位微出血，但神经功能检查结果未恶化。1例患者新发脑梗死并伴有神经功能缺损。所有患者均未出现神经功能恶化。中位随访时间为26个月。5年后总生存率为90.7%。
我们使用甲磺酸萘莫司他的策略使我们能够在颅内出血患者中安全地进行早期手术，且不会加重出血。
