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Titolo:
URGENT VALVE SURGERY AFTER ACUTE CEREBRAL EMBOLISM DURING INFECTIVE ENDOCARDITIS
Autore:
HORSTKOTTE D; PIPER C; WIEMER M; ARENDT G; STEINMETZ H; BERGEMANN R; SCHULTE HD; SCHULTHEISS HP;
Indirizzi:
FREE UNIV BERLIN,KLINIKUM BENJAMIN FRANKLIN,MED KLIN & POLIKLIN 2,KLIN KARDIOL & PNEUMOL D-12200 BERLIN GERMANY
Titolo Testata:
Medizinische Klinik
fascicolo: 5, volume: 93, anno: 1998,
pagine: 284 - 293
SICI:
0723-5003(1998)93:5<284:UVSAAC>2.0.ZU;2-W
Fonte:
ISI
Lingua:
GER
Soggetto:
BLOOD-BRAIN-BARRIER; NEUROLOGIC COMPLICATIONS; BACTERIAL-ENDOCARDITIS; INTRACRANIAL HEMORRHAGE; ISCHEMIA; INFARCTION; MECHANISMS; PERMEABILITY; FAILURE; STROKE;
Keywords:
ENDOCARDITIS; CARDIOEMBOLISM; CEREBRAL EMBOLISM; URGENT VALVE REPLACEMENT SURGERY; CEREBRAL HEMORRHAGE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
60
Recensione:
Indirizzi per estratti:
Citazione:
D. Horstkotte et al., "URGENT VALVE SURGERY AFTER ACUTE CEREBRAL EMBOLISM DURING INFECTIVE ENDOCARDITIS", Medizinische Klinik, 93(5), 1998, pp. 284-293

Abstract

Background: The indication for urgent cardiac surgical interventions in patients with active infective endocarditis has to be considered carefully following thromboembolic events, because of the high recurrence rate of such complications. In the case of brain embolisms the prognostic benefit of urgent surgery has been discussed controversially as effective anticoagulation during open heart surgery may result in secondary cerebral hemorrhages. Patients and Methods: Between 1978 and 1993 infective endocarditis (IE) was proven in 288 consecutive and prospectively followed patients (131 females, 157 males;mean age 53.6 +/- 8.7 [9 to 81] years). To analyze potential benefits and risks I of an urgent surgical intervention early after embolic cerebral infarction, cumulated survival rates were calculated for patients with and without surgical intervention with special reference to incremental risk factors and the timing of surgery. Results: In 50 patients (17.4%) the clinical course was complicated by one, and in 58 patients (20.2%) by recurrent embolic events. In 80% the first embolism occurred within 33 daysfollowing the first manifestation of typical signs and symptoms of IE. 80% of recurrent events were observed within 32 days follow following the initial embolism. 71% of all embolic events were cerebral. Inpatients with cerebral embolism corroborated by computed tomography (CCT), the clinical course was complicated by intracranial hemorrhage in 12.5% while it ,was only 1.5% for patients without cerebral embolism. Because of a lack of therapeutic alternatives, 22 of 49 patients with recurrent embolic events, of which at least one was cerebral, underwent urgent cardiac surgery within 4 to 366 hours after the first cerebral manifestation. The cumulated survival rate of patients operated within72 hours after the initial cerebral embolism was significantly more favorable (p less than or equal to 0.000) than for unoperated patients or those who were : operated after more than 8 days. Conclusion: An embolic event during IE carries a more than 50% risk of recurrence. In patients with short duration of signs and symptoms of IE and postembolic echocardiographic demonstration of persistent vegetations the probability is > 80%. At least for those patients urgent surgical intervention to remove the source of infection and embolic hazard seems to be beneficial. Surgical intervention using the heart-lung-machine should beperformed within 72 hours. Such early timing results in a significantlower fate of secondary cerebral hemorrhages (p less than or equal to0.000) than a postponed operation. To exclude early reperfusion fusion hemorrhage due to spontaneous thrombus fragmentation, CCT should be repeated directly preoperatively.

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Documento generato il 29/03/20 alle ore 15:01:05