Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe

Mehrdad Ghoreishi, Nate Foster, Chetan Pasrija, Aakash Shah, A. Claire Watkins, Charlie F. Evans, Sam Maghami, Rachael Quinn, Brody Wehman, Bradley S. Taylor, Murtaza Y. Dawood, Bartley P. Griffith, James S. Gammie

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5 Citations (Scopus)

Abstract

Background To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. Methods From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist. Results Among patients presenting with stroke, 33% (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4% (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4% (7 of 174 patients) among patients with no preoperative stroke and 4% (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7% (13 of 174 patients) among patients with no preoperative stroke and 7% (5 of 69 patients) among patients with stroke (p = 0.9). Conclusions MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed.

Original languageEnglish (US)
Pages (from-to)69-75
Number of pages7
JournalAnnals of Thoracic Surgery
Volume105
Issue number1
DOIs
StatePublished - Jan 2018

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Endocarditis
Mitral Valve
Stroke
Nervous System

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Ghoreishi, Mehrdad ; Foster, Nate ; Pasrija, Chetan ; Shah, Aakash ; Watkins, A. Claire ; Evans, Charlie F. ; Maghami, Sam ; Quinn, Rachael ; Wehman, Brody ; Taylor, Bradley S. ; Dawood, Murtaza Y. ; Griffith, Bartley P. ; Gammie, James S. / Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 1. pp. 69-75.
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title = "Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe",
abstract = "Background To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. Methods From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72{\%} (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28{\%} (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist. Results Among patients presenting with stroke, 33{\%} (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4{\%} (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4{\%} (7 of 174 patients) among patients with no preoperative stroke and 4{\%} (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7{\%} (13 of 174 patients) among patients with no preoperative stroke and 7{\%} (5 of 69 patients) among patients with stroke (p = 0.9). Conclusions MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed.",
author = "Mehrdad Ghoreishi and Nate Foster and Chetan Pasrija and Aakash Shah and Watkins, {A. Claire} and Evans, {Charlie F.} and Sam Maghami and Rachael Quinn and Brody Wehman and Taylor, {Bradley S.} and Dawood, {Murtaza Y.} and Griffith, {Bartley P.} and Gammie, {James S.}",
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Ghoreishi, M, Foster, N, Pasrija, C, Shah, A, Watkins, AC, Evans, CF, Maghami, S, Quinn, R, Wehman, B, Taylor, BS, Dawood, MY, Griffith, BP & Gammie, JS 2018, 'Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe', Annals of Thoracic Surgery, vol. 105, no. 1, pp. 69-75. https://doi.org/10.1016/j.athoracsur.2017.06.069

Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe. / Ghoreishi, Mehrdad; Foster, Nate; Pasrija, Chetan; Shah, Aakash; Watkins, A. Claire; Evans, Charlie F.; Maghami, Sam; Quinn, Rachael; Wehman, Brody; Taylor, Bradley S.; Dawood, Murtaza Y.; Griffith, Bartley P.; Gammie, James S.

In: Annals of Thoracic Surgery, Vol. 105, No. 1, 01.2018, p. 69-75.

Research output: Contribution to journalArticle

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T1 - Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe

AU - Ghoreishi, Mehrdad

AU - Foster, Nate

AU - Pasrija, Chetan

AU - Shah, Aakash

AU - Watkins, A. Claire

AU - Evans, Charlie F.

AU - Maghami, Sam

AU - Quinn, Rachael

AU - Wehman, Brody

AU - Taylor, Bradley S.

AU - Dawood, Murtaza Y.

AU - Griffith, Bartley P.

AU - Gammie, James S.

PY - 2018/1

Y1 - 2018/1

N2 - Background To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. Methods From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist. Results Among patients presenting with stroke, 33% (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4% (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4% (7 of 174 patients) among patients with no preoperative stroke and 4% (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7% (13 of 174 patients) among patients with no preoperative stroke and 7% (5 of 69 patients) among patients with stroke (p = 0.9). Conclusions MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed.

AB - Background To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. Methods From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist. Results Among patients presenting with stroke, 33% (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4% (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4% (7 of 174 patients) among patients with no preoperative stroke and 4% (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7% (13 of 174 patients) among patients with no preoperative stroke and 7% (5 of 69 patients) among patients with stroke (p = 0.9). Conclusions MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed.

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