Key result
Preoperative symptomatic neurological complications are not linked to higher postoperative mortality in early left-sided IE surgery.
Why the study?
It was unclear whether preoperative symptomatic neurological complications predict a worse prognosis in patients with active left-sided infective endocarditis requiring early surgery.
Does the presence and timing of preoperative symptomatic neurological complications affect mortality in patients with active left-sided infective endocarditis requiring early surgery?
Cohort (n=212)
No
Does the presence and timing of preoperative symptomatic neurological complications affect mortality in patients with active left-sided infective endocarditis requiring early surgery?
Absolute Event Rate: 29.8% vs 31.5%
p-value: p=0.821
In patients with active left-sided infective endocarditis requiring early surgery, preoperative neurological complications do not significantly worsen long-term survival, though surgery within the first week of a neurological event increases the risk of mortality or hemorrhagic transformation.
Preoperative SNC was associated with higher mortality after early surgery for left-sided IE; hypothesis-generating and should not yet change practice.
Introduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery. Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immediate, medium-term, and long-term mortality in patients with active left-sided infective endocarditis who required early surgery (median follow-up: 70.5 months). Results: Of 212 included patients, preoperative SNCs occurred in 22.1%. Independent risk factors for preoperative SNC included early hospital admission (<10 days after symptoms onset), duration of antibiotic therapy <7 days, vegetation diameter > 30 mm, preoperative chronic therapy with steroids, and peripheral embolism. A new postoperative SNC occurred in 12.7% of patients. No significant differences related to preoperative or postoperative SNCs were observed in postoperative mortality (29.8% vs. 31.5%) or during follow-up. No significant differences in postoperative mortality were observed between hemorrhagic or ischemic SNCs. There was a non-significant trend to increased mortality in patients who underwent surgery within 7 days of presenting with SNC (55.5%) compared to those who underwent surgery more than 7 days after SNC (33.3%) (P = 0.171). Concomitant risk of mortality or postoperative hemorrhagic transformation increased when surgery is required during the first week after preoperative SNC (77.5% vs. 25%) (P = 0.017). Conclusions: Patients with active left-sided infective endocarditis who need early hospital admission are at a higher risk of SNC. Mortality is higher in patients who underwent surgery within 7 days of SNC, but mortality of early surgery is acceptable after the first week of preoperative ischemic or hemorrhagic complication. We have not been able to demonstrate that preoperative nor postoperative SNCs predicted a reduced immediate, medium-term, or long-term survival in the population analyzed in this study.
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Carrascal et al. (2021) conducted a cohort in Active left-sided infective endocarditis (n=212). Preoperative symptomatic neurological complication vs. No preoperative symptomatic neurological complication was evaluated on Postoperative mortality (p=0.821). Preoperative symptomatic neurological complications did not significantly increase postoperative mortality (29.8% vs. 31.5%, p=0.821) in patients with active left-sided infective endocarditis requiring early surgery.
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