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


Cite item

Full Text

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.

About the authors

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
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 Russian Federation

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
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. Russian Federation

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

References

  1. Alekhin M. N., M Rybkova.To., Sidorenko B. A., etc. Znachenie ehkhokardiografii v diagnostike infekcionnogo ehndokardita. Kardiologiya [the Value of echocardiography in the diagnosis of infectious endocarditis. Cardiology] 2005; 45:6; 4-13.
  2. Bockeria L. A., Abdulkasimov S. K., Bogachev-Prokofiev A. B. and etc. Nacional'nye rekomendacii po vedeniyu, diagnostike i lecheniyu klapannyh porokov serdca.[the National guidelines for the management, diagnosis and treatment of valvular heart disease.] M: publishing house of the NTS AOA im A. N. Bakulev of the Russian Academy of medical Sciences 2009; 356.
  3. In Bulynin.And., Glukhov A. A., Moshuriv I. P. Lechenie RAN. Voronezh: Izdatel'stvo Voronezhskogo gosudarstvennogo universiteta [Treatment of wounds. Voronezh: Publishing house Voronezh state University] 1998; 248.
  4. Vinogradova T. E. Insul't v kardiohirurgii. Patologiya krovoobrashcheniya i kardiohirurgiya [Stroke in cardiac surgery. Pathology of circulation and cardiac surgery] 2010; 3: 30-34.
  5. Gurevich M. A. Tazina S. J., Savitskaya.And. Sovremennyj infekcionnyj ehndokardit. [Modern infectious endocarditis.] M.: MONICA 2001; 229.
  6. Kislyak S. V., And Reznik.And., Idov E. M., et al. Tromboehmbolicheskim sindromom pri infekcionnom ehndokardite. Kardiovaskulyarnaya terapiya i profilaktika [Thromboembolic syndrome in infective endocarditis. Cardiovascular therapy and prevention] 2009; 8:5: 154-155.
  7. Nekrasova N. In., Minakov E. V., Sobolev, Y. A. Vliyanie serdechnoj nedostatochnosti na prognoz u bol'nyh infekcionnym ehndokarditom. Rossijskij kardiologicheskij zhurnal. [the Influence of heart failure on prognosis in patients with infective endocarditis. Russian journal of cardiology.] Moscow: 2005; 27-33.
  8. Nikolaev E. N., Khubulava G. G., Udaltsov B. B. Infekcionnyj ehndokardit (sovremennoe sostoyanie problemy). [infective endocarditis (current state of the problem).] Camapa: Afort 2006; 198.
  9. In Eaves.And., L Kuznetsova.M. In Ivanov.And. etc.EHkhokardiografiya v diagnostike infekcionnogo ehndokardita v kardiohirurgicheskoj klinike. Ul'trazvukovaya i funkcional'naya diagnostika [Echocardiography in the diagnosis of infectious endocarditis in a cardiac surgery clinic. Ultrasonic and functional diagnostics] 2013; 2: 35-42.
  10. In Tyurin.P. Infekcionnye ehndokardity: rukovodstvo. [Infectious endocarditis: a guide.] M: GEOTAR–Med. 2012; 368.
  11. In Tyurin.P. Faktory riska razvitiya tromboehmbolii i tromboza pri infekcionnom ehndokardite i sposoby ih snizheniya. Kardiovaskulyarnaya terapiya i profilaktika [Risk factors for embolism and thrombosis in infective endocarditis and ways to reduce them. Cardiovascular therapy and prevention] 2008; 7:S22: 372b-373.
  12. Shevchenko Yu. l. Hirurgicheskoe lechenie infekcionnogo ehndokardita. [Surgical treatment of infective endocarditis.] SPb: Nauka. 1995; 230.
  13. Shahverdiev N. N., Marchenko S. P. Osnovy rekonstruktivnoj hirurgii klapanov serdca. [fundamentals of reconstructive surgery of heart valves.] SPb: Deaton. 2007; 340.
  14. In Shumakov.And., Shumakov D. V., Mukha V. A., etc. Hirurgicheskoe lechenie oslozhnennyh form infekcionnogo ehndokardita. Vestnik transplantologii i iskusstvennyh organov [Surgical treatment of complicated forms of infectious endocarditis. Bulletin of Transplantology and artificial organs] 2006; 8:4: 62-63.
  15. Bonow, B. A. Carabello, K. Chatterjee, A. C. et al. ACC/Aha 2006 Rekomendacii po vedeniyu pacientov s porokami serdca: doklad amerikanskogo kolledzha kardiologii/amerikanskoj Associacii serdca celevoj gruppy po prakticheskie rekomendacii, razrabotannye v sotrudnichestve s obshchestvom serdechno-sosudistyh anesteziologov, obshchestvom serdechno-sosudistoj Angiografii i intervencij odobreno i obshchestvo Torakal'nyh hirurgov. YA Koll Evroremontom[guidelines for the management of patients with valvular heart disease: a report of the American College of cardiology/American heart Association task force on practical guidelines developed in collaboration with the society of cardiovascular anesthesiologists endorsed by the society cardiovascular Angiography and interventions and society of Thoracic surgeons. I Coll Cardiol] 2006; 48;3: 1 -148.
  16. Cabell C. H., K. K. pond, G. E. Peterson et al. Risk insul'ta i smerti u pacientov s aortal'nym i mitral'nym klapanom ehndokardit. [The risk of stroke and death in patients with aortic and mitral valve endocarditis.] I Heart J 2001; 142: 75-80.
  17. De Castro, S., magni g, Beni S., et al. Rol' transtorakal'noj i chrespishchevodnoj ehkhokardiografii v prognozirovanii sobytij ehmbolii u pacientov s aktivnym infekcionnym ehndokarditom s uchastiem nativnyh klapanov serdca. [Role of transthoracic and transesophageal echocardiography in predicting embolic events in patients with active infective endocarditis involving native heart valves.] I In J Cardiol 1997; 80: 1030-1034.
  18. Deprele S., P. Berthelot, F. Lemetayer et al. Faktory riska sistemnoj ehmbolii pri infekcionnom ehndokardite. Mikrobiologiya Clin Zarazit' [Risk factors systemic embolism in infective endocarditis. Clin Microbiology Infect] 2004; 10: 46-53.
  19. Eishi K, Kawazoe K, Kuriyama Y. et al. Hirurgicheskoe lechenie infekcionnogo ehndokardita, svyazannogo s cerebral'nym oslozhneniyam: mnogocentrovoe retrospektivnoe issledovanie v YAponii. Kn J v hirurgii vzr [Surgical treatment of infectious endocarditis associated with cerebral complications: multi-center retrospective study in Japan. KN J Thorac Surgery] 1995; 110: 1745-1755.
  20. Epaulard O., Rocha, N. V. Potton, L. et al. Infekcionnyj ehndokardit, svyazannye s insul'tom: zaderzhka diagnostiki i prognosticheskie faktory. [Infective endocarditis-related stroke: delay of diagnosis and prognostic factors.] SCAND J Infect Dis; 2009; 41(8): 558-62.
  21. Garcia Cabrera, E., de Hidalgo, N. B., Almirante, B. et al. Nevrologicheskie oslozhneniya infekcionnogo ehndokardita faktory riska, itogi i posledstviya kardiohirurgii: mnogocentrovoe observacionnoe issledovanie. Tirazh[Neurological complications of infective endocarditis risk factors, outcome, and impact of cardiac surgery: a multicenter observational study. Circulation] 2013; 127(23): 2272-2284.
  22. A. S. Haines, Z. Bahrami Astroulakis T. et al. V nachale operacii ili lecheniya ehndokardita, oslozhnennogo ehmboliej iz bol'shogo, mobil'nogo rastitel'nosti? Obsuzhdeniya po delu. [At the beginning of the operation or treatment of endocarditis, complicated by embolism from a large, mobile vegetation? The case discussion.] J. Heart Valve Dis", 2006; 15:4: 567-569.
  23. S. Homma Grahame–Clarke C. k umen'sheniyu tromboehmbolicheskih oslozhnenij, infekcionnogo ehndokardita. [toward reducing the thromboembolic complications of infective endocarditis.] J Am Coll Cardiol 2003; 42:5: 781-783.
  24. Matsushita K. Kuriyama, Y. Sawada, T. et al. Gemorragicheskih i ishemicheskih cerebrovaskulyarnyh oslozhnenij aktivnogo infekcionnogo ehndokardita nativnyh klapanov. [Hemorrhagic and ischemic cerebrovascular complications of active infective endocarditis of native valve.] EUR Neurol, 1993; 33:3: 267-274.
  25. Nashef, S. A., Roques F., Michel P., et al. Sistema evropejskij serdechnoj operativnoj ocenki riska (EuroSCORE). Evro operacii ot J Cardiothorac [Europaen system for cardiac operative risk evaluation (EuroSCORE). EUR J Cardiothorac Surgery] 1999; 16: 9-13.
  26. Okazaki, S., Yoshioka, D., Sakaguchi M. et al. Ostryh ochagov ishemii golovnogo mozga pri infekcionnom ehndokardite: zabolevaemost', faktory i posleoperacionnyh rezul'tatov. Cerebrovaskulyarnye Zabolevaniya [Acute ischemic brain lesions in infective endocarditis: incidence, factors and postoperative outcome. Cerebrovascular Diseases] 2013; 35:155-162.
  27. Prendergast B. D. menyayushcheesya lico infekcionnyj ehndokardit. Serdce [the changing face of infective endocarditis. Heart] 2006; 92: 879-885.
  28. Snygg-Martin, U., Rasmussen, R. V., C. Hassager et al. Varfarina i chastotu cerebrovaskulyarnyh oslozhnenij pri levostoronnem rodnoj klapan ehndokardit. Evropejskom zhurnale klinicheskoj mikrobiologii i infekcionnyh zabolevanij [Of warfarin and the frequency of cerebrovascular complications in left-sided native valve endocarditis. European journal of clinical Microbiology & infectious diseases,] 2010; 30:2: 151-157.
  29. A. Vahanian, O. Alfieri, F. Andreotti et al. Rekomendacii po lecheniyu klapannyh porokov serdca (Versiya 2012):sovmestnaya celevaya gruppa po upravleniyu klapannoj bolezni serdca Evropejskogo obshchestva kardiologov (ESC) i Evropejskoj associacii kardio-torakal'noj hirurgii (EACTS). Serdce Dzhej-Evro [Guidelines for management of valvular heart disease (Version 2012):joint task force on management of valvular heart disease of the European society of cardiology (ESC) and European Association for cardio-thoracic surgery (EACTS). Heart Jay-UEFA Euro] 2012; 33: 2451-2496.
  30. Watkyn R., Sandoe J. Britanskogo obshchestva po antimikrobnoj himioterapii (bsac) rekomendacii po diagnostike i lecheniyu ehndokardita: chto kardiolog dolzhen znat'. Serdce (Britanskogo Kardiologicheskogo Obshchestva) [British society for antimicrobial chemotherapy (bsac) guidelines for the diagnosis and treatment of endocarditis: what the cardiologist needs to know. Heart (British Cardiac Society)] 2012; 98:10: 757-759.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 ., ., .

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies