Impact of cerebral complications in acute infective endocarditis: a retrospective single-center study

Abstract

Abstract BACKGROUND The treatment of patients with infective endocarditis (IE) who have cerebral complications remains less understood. Therefore, this study aimed to retrospectively evaluate the clinical outcomes of patients with acute IE based on preoperative intracranial findings. METHODS Of 32 patients with acute IE treated at our hospital between August 2015 and March 2022, 31 patients of whom preoperative intracranial imaging evaluation was available were included in our analysis and compared with those with and without intracranial findings. The preoperative background, intraoperative findings, cardiopulmonary bypass (CPB) data, and postoperative courses were reviewed. RESULTS Among the 31 patients, 20 (65%) had preoperative imaging findings. The group with intracranial findings was significantly older, with more embolisms in other organs and positive intraoperative pathology findings. Patients with intracranial findings had significantly longer CPB times. A new cerebral hemorrhage developed postoperatively in one patient without intracranial findings. There were no early deaths; two patients had recurrent infections in each group, and one died as a result of sepsis in the late phase in the group with intracranial findings. CONCLUSIONS Positive intracranial findings indicated significantly active infectious conditions preoperatively but did not affect the postoperative course. Patients without cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without lesions.