Cardiac surgery in infective endocarditis with neurological complications: Identifying prognosis risk factors in mortality and handicap at 6 months

Abstract

Neurological complications of infective endocarditis (IE) concerns 20–40% of cases when symptomatic and 70% when asymptomatic. It is a well-identified gravity factor. Surgical indications in IE are larges and usual in emergency situations. However, neurological event, symptomatic or not, counts in surgical discussion. Sub-groups of patients with real risk of neurological deterioration during extracorporeal circulation are difficult to identify. The purpose of this study was to identify the risk factors of death and handicap in patients operated for infective endocarditis with neurological complications. Retrospective monocentric study realized in CHU of Toulouse from October 2014 to March 2017. We included 78 patients treated by cardiac surgery in a context of infective endocarditis complicated by neurological event (ischemic or hemorrhagic stroke, meningitis or mycotic aneurysm). The primary endpoint was mortality and Rankins score greater than or equal to 2, at six month. Primary endpoint occurred in 21 patients (26%). Risk factors were anteriority of mechanical valve replacement ( P = 0,004), pejorative SOFA score ( P < 0,0001), diabetes ( P = 0,005), high Euroscore ( P = 0,0004), infection by methicillin-sensitive Staphylococcus aureus ( P = 0,033), oral streptococcus ( P = 0,037) initial hemodynamic instability ( P = 0,005), aminoside treatment ( P = 0,001), duration of reanimation ( P = 0,004), vasopressive drugs use and mechanical ventilation pre and post-surgery. However, we did not find significative results to several variables as hemorrhagic stroke ( P = 0,69), surgery delay ( P = 0,324), neurological symptoms ( P = 0,120), Glasgow score ( P = 0,146) and oral anticoagulation ( P = 0,211) ( Fig. 1 ). Main risk factors of death or handicap at six month, after a cardiac surgery in context of IE with neurological complication were hemodynamic presentation, micro organism and diabetes.