engleski

Influence of cardiac surgery on the outcome of patients with infective endocarditis complicated with hemorrhagic stroke

Background: Stroke occurs in about 20% of patients with IE. In a previous study we showed that cardiac surgery (CS) during acute episode of IE decreases intrahospital mortality. Common assumption is that cardiac surgeons are generally reluctant to perform surgery in patients with hemorrhagic stroke. The aim was to assess the influence of cardiac surgery on patients’ outcome in group of patients with IE complicated with hemorrhagic stroke. Methods and results: From January 1, 2000 and August 31 2005, 2760 cases of definite IE were included by 61 centers in 28 countries. Each center utilized a standard case report form. Stroke was characterized as ischemic or hemorrhagic using neuroimaging results. Hemorrhagic strokes included primary intracerebral hemorrhages, hemorrhagic infarction and subarachnoid hemorrhage. Hemorrhagic stroke occurred in 160 (5.8%) of 2760 patients with IE. Mean age of patients was 53.2± 14.5 years. Male gender dominated (101 patients, 63.1%). Cardiac surgery was performed in 64 (40%) patients. Embolizations and presence of vegetations were the most common indication for surgery. These indications were reported in 34 (53.1%) patients, followed by heart failure in 29 (45.3%) patients. Overall intrahospital mortality in patients with hemorrhagic stroke was 40%. Thirteen (20.3%) of 64 operated patients died vs 51/96 (53.1%) not operated. Chances for intrahospital survival were more than four times higher in patients in whom CS was performed (OR=4.45, 95% CI 2.1– 9.2). Conclusions: Cardiac surgery should not be sustained in patients with IE complicated with hemorrhagic stroke. Cardiac surgery improves patient’ s survival in patients with hemorrhagic stroke during IE.

IE; stroke; cardiac surgery; outcome

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