Risk Stratification for Embolic Events in Surgical Patients with Left-Sided Infective Endocarditis

Abstract


The purpose of the study This study was aimed to determine the structure and identify risk factors associated with the development of embolic events in surgical patients with left-sided infective endocarditis. Materials and methods The cohort includes 238 patients with left-sided infective endocarditis who underwent valve replacement surgery. All thromboembolic events which have occurred before, during and after surgery were studied. The influence of the basic epidemiologic, clinical, microbiological, echocardiographic, and laboratory data on the cases of embolism was analyzed. Results and their discussion In-hospital mortality in general cohort was 9.24%; in the group of patients with embolic events it was 11.54%, and in the event-free group it was 8.60%. The mortality in the sub-group with pre-surgical embolic events was 8.33%, and in the sub-group with post-surgical embolic events it was 18.75% (all deaths occurred in this sub-group were related to embolisms). In patient group with embolic events and in the event-free group mitral valve impairment was reported to occur in 44.23% and 31.72% of cases, respectively. Vegetations were reported in 93.28% of patients. Transesophageal echocardiography showed higher sensitivity in comparison with transthoracic echocardiography for vegetations located on mitral valve only (p≤0.05). The relation was confirmed between pre-surgical embolic episodes and bulky mobile vegetations (p<0.05). In 43.75% of cases thromboembolic episodes in post-surgical period took place after both mitral and aortic valves replacement, most post-surgical embolisms occurred within the first three days after the surgery. Conclusion Major risk-factors associated with pre-surgical embolic events in patients with left-sided infective endocarditis were: active infective endocarditis, mitral valve lesion, and large mobile vegetations. The embolic events which have occurred before surgery did not affect hospital mortality. Intra- and post-surgical embolic events in left-sided IE patients were not related to the risk factors associated with pre-surgical embolisms and were found to increase in-hospital mortality risk. The highest risk of postoperative embolism appeared to be in early post-surgical period. Key words Infective endocarditis, surgical treatment, embolic events, risk factors.

Voronezh State Regional Clinical Hospital, 151 Moskovskii Ave.,Voronezh, 394036, Russian Federation
N.N. Burdenko Voronezh State Medical Academy, 10 Studencheskaia Str.,Voronezh, 394036,
Russian Federation

Author for correspondence.
Email: mail@vestnik-surgery.com

Russian Federation MD, PhD, Professor, Head of Cardiac Surgery Department No1 of the Voronezh State Regional Clinical Hospital, Head of Voronezh Cardiac Surgery Center, Chief Cardiovascular Surgeon of Voronezh Region; Professor of Hospital Surgery Chair of the Voronezh Burdenko State Medical Academy

Voronezh State Regional Clinical Hospital, 151 Moskovskii Ave.,Voronezh, 394036, Russian Federation
N.N. Burdenko Voronezh State Medical Academy, 10 Studencheskaia Str.,Voronezh, 394036,
Russian Federation

Email: dgryaznov@hotmail.com

Russian Federation MD. Cardiovascular Surgeon of the Department of Cardiac Surgery No1 of the Voronezh State Regional Clinical Hospital; Assistant Lecturer of the Hospital Surgery Chair of the Voronezh Burdenko State Medical Academy.

Voronezh State Regional Clinical Hospital, 151 Moskovskii Ave.,Voronezh, 394036, Russian Federation
N.N. Burdenko Voronezh State Medical Academy, 10 Studencheskaia Str.,Voronezh, 394036,
Russian Federation

Email: mail@vestnik-surgery.com

Russian Federation Cardiologist of the Department of Cardiac Surgery No2 of the Voronezh State Regional Clinical Hospital.

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