Abstract Details

Title Infective Endocarditis with Cerebrovascular Complications: When Is the Optimal Time To Decide the Cardiac Surgery?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 247

Objective

Background BACKGROUND: Management of infective endocarditis (IE) with cerebrovascular complications is difficult due to absence of concrete evidence. The optimal timing for cardiac surgery is unknown in these cases.

Design/Methods DESIGN/METHODS: We evaluated demographic data, clinical, surgical and prognosis aspects of patients with IE.

Results RESULTS: Between 2010 and 2012, 34 patients were admitted with IE. The mean age was 62 ± 18 years, and 44 % female. In 44% of patients (n:15) we detected neurological compromise. Cerebrovascular complications included: cerebral infarction (n = 14, 41%), cerebral hemorrhage (n=2, 5.8 %) and mycotic aneurysm (n = 1, 3%). The most common valvular localizations were aortic 44 % (n=15) and mitral 38% (n=13). The Staphylococcus aureus was the organism most frequently involved in patients with cerebrovascular events. The patient with mycotic aneurysm, was subjected to clipping before cardiac surgery. The mean time between craniotomy and cardiac surgery was 21 days. and from antibiotic therapy onset to cardiac surgery was 10 ± 14 days in all cases. In 80 % of patients with cerebrovascular compromise the cardiac surgery was performed within two weeks after the antibiotic treatment was indicated. The main cause to carry out the valvular surgery was significant congestive heart failure or valvular regurgitation, recurrence of embolism under adequate antibiotic therapy, myocardial abscess, persistent bacteremia and large-size vegetations with high risk of embolism. Post-operative neurological deterioration was observed in one case. The hospital mortality rate was 21 %( n=7) and was similar in patients with and without cerebrovascular complications.

Conclusions CONCLUSIONS: Management of IE with cerebrovascular complications should be based on case-by-case multidisciplinary assessment. Only selected cases with cardiac failure, severe valvular dysfunction or recurrence of embolism can be elegible during the acute period of cerebrovascular event, for surgery without increase of the mortality.

Authors/Disclosures
Maria C. Zurru, MD PRESENTER	No disclosure on file
Maria Zurru	No disclosure on file
	No disclosure on file
Myla D. Goldman, MD, MSc, FAAN (Virginia Commonwealth University)	Dr. Goldman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentec. Dr. Goldman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Immunic. Dr. Goldman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis Pharmceuticals. Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kiniska. Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainstorm Cell Therapeutics Ltd., . Dr. Goldman has received personal compensation in the range of $500-$4,999 for serving as a Study Section Member with NIH. Dr. Goldman has received personal compensation in the range of $0-$499 for serving as a Grant Review Committee Member with Department of Defense.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Edgardo Cristiano, MD (Hospital Italiano De Buenos Aires)	Dr. Cristiano has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Cristiano has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. Dr. Cristiano has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genzyme. Dr. Cristiano has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Cristiano has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck.

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