Abstract TP411: Preoperative Anemia a Significant Risk Factor for Postoperative Intracranial Hemorrhage in Active Infective Endocarditis
Background: Patients with infective endocarditis (IE) are often associated with cerebrovascular lesions which may cause critical postoperative intracranial hemorrhage (ICH). Although it has been known that postoperative ICH is not related to operative timing, prevalence or predictors is not fully understood. We thereby hypothesized that postoperative ICH in active IE may be predictable by thorough preoperative investigations including brain imaging modalities.
Methods: A series of 102 patients who were diagnosed and surgically treated for active IE according to the AHA/ACC guideline was studied. All patients were preoperatively and postoperatively examined by brain magnetic resonance imaging and/or computed tomography scan regardless of the neurological symptom. Of them, 48 patients (47%) had cerebral complications preoperatively.
Results: Surgery was performed at 19 ± 27 days after the diagnosis. In-hospital mortality occurred in 12 patients (11.7%), 2 of which were related to postoperative ICH. New neurological symptoms postoperatively appeared in 3 patients (2.9%), while postoperative ICH was identified in 11 patients (10.8%), presenting with ectopic cerebral bleeding in 3 patients, subdural hematoma in 3 patients, acute subarachnoid hemorrhage in 4 patients and, postinfarct hemorrhagic transformation in 1 patient. Logistic regression analysis identified preoperative anemia as sole independent risk factor for postoperative ICH with cutoff value being preoperative hemoglobin level of 8.5 g/dl (odds ratio; 2.37, P <0.01). Early surgery, preoperative presence of cerebral infarction/hemorrhage or bacterial species was not an independent risk factor of postoperative ICH.
Conclusions: ICH occurred in 10.8% after the surgery for active IE. Preoperative anemia is the sole predictor of postoperative ICH, whereas preoperative cerebral complications or surgical timing was not a significant predictor, suggesting that preoperative management may be important in preventing postoperative ICH in active IE.
- © 2012 by American Heart Association, Inc.