Universität zu Köln

Dashkevich, Alexey, Bratkov, Georg, Li, Yupeng, Joskowiak, Dominik, Peterss, Sven ORCID: 0000-0003-1880-152X, Juchem, Gerd, Hagl, Christian and Luehr, Maximilian (2021). Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism-The Risk of Intermediate Deterioration. J. Clin. Med., 10 (10). BASEL: MDPI. ISSN 2077-0383

Full text not available from this repository.

Abstract

Cerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients' outcomes and define the potential risk factors with regard to surgical timing for IE patients with preoperative symptomatic cerebral embolism (CE). A total of 119 IE patients with CE were identified and analyzed with regard to operative timing: early (1-7 days), intermediate (8-21 days), and late (>22 days). The preoperative patient data, comorbidities and previous cardiac surgical procedures were analyzed to identify potential predictors and independent risk factors for in-hospital mortality using univariate and multivariate regression analysis. Actuarial survival was estimated by the Kaplan-Meier method. In-hospital mortality for the entire study cohort was 15.1% (n = 18), and in comparison, between groups was found to be highest in the intermediate surgical group (25.7%). Univariate analysis identified preoperative mechanical ventilation dependent respiratory insufficiency (p = 0.006), preoperative renal insufficiency (p = 0.019), age (p = 0.002), large vegetations (p = 0.018) as well as intermediate (p = 0.026), and late (p = 0.041) surgery as predictors of in-hospital mortality. The presence of large vegetations (>8 mm) (p = 0.019) and increased age (p = 0.037)-but not operative timing-were identified as independent risk factors for in-hospital mortality. In the presence of large vegetations (>8 mm), cardiac surgery should be performed early and independently from the entity of cerebral embolic stroke. Postponing surgery to achieve clinical stabilization and better postoperative outcomes of IE patients with CE is reasonable, however, worsening of the disease process with deterioration and resulting heart failure during the first 3 weeks after CE results in a significantly higher in-hospital mortality and inferior long-term survival.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Dashkevich, Alexey UNSPECIFIED UNSPECIFIED UNSPECIFIED Bratkov, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Li, Yupeng UNSPECIFIED UNSPECIFIED UNSPECIFIED Joskowiak, Dominik UNSPECIFIED UNSPECIFIED UNSPECIFIED Peterss, Sven UNSPECIFIED orcid.org/0000-0003-1880-152X UNSPECIFIED Juchem, Gerd UNSPECIFIED UNSPECIFIED UNSPECIFIED Hagl, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Luehr, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-579697
DOI:	10.3390/jcm10102136
Journal or Publication Title:	J. Clin. Med.
Volume:	10
Number:	10
Date:	2021
Publisher:	MDPI
Place of Publication:	BASEL
ISSN:	2077-0383
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CEREBROVASCULAR COMPLICATIONS; SURGICAL-MANAGEMENT; CARDIAC-SURGERY; SIZE Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/57969