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Abstract：
BACKGROUND: The treatment of patients with infective endocarditis (IE) who have preoperative 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. We controlled the mean arterial blood pressure and activated clotting time (ACT) to prevent abnormally high perfusion pressures and ACTs during cardiopulmonary bypass (CPB). The preoperative background, and postoperative courses focusing on postoperative brain complications 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, positive intraoperative pathology findings, and 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 because 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 preoperative cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of preoperative cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without 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. We controlled the mean arterial blood pressure and activated clotting time (ACT) to prevent abnormally high perfusion pressures and ACTs during cardiopulmonary bypass (CPB). The preoperative background, and postoperative courses focusing on postoperative brain complications 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, positive intraoperative pathology findings, and 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 because 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 preoperative cerebral complications can develop serious cerebral hemorrhage. Although meticulous examination of preoperative cerebral complications in all patients with IE is essential, a strategy should be adopted to prevent cerebral hemorrhage, even in patients without intracranial findings.
摘要：
背景：感染性心内膜炎（IE）患者术前脑并发症的治疗方法尚不清楚。因此,本研究旨在根据术前颅内检查结果对急性IE患者的临床结局进行回顾性评估.
方法：2015年8月至2022年3月在我院接受治疗的32例急性IE患者中，有31例术前可进行颅内影像学评估，并与有和无颅内发现的患者进行比较。我们控制平均动脉血压和激活凝血时间（ACT），以防止体外循环（CPB）期间异常高的灌注压和ACT。术前背景，并对术后脑部并发症的术后疗程进行了回顾。
结果：在31例患者中，20例（65%）有术前影像学表现。有颅内发现的组明显年龄较大，其他器官有更多的栓塞，术中病理结果阳性，和更长的CPB时间。一名无颅内发现的患者术后出现新的脑出血。没有早期死亡；每组有两名患者反复感染，在有颅内发现的组中，有1人死于晚期脓毒症。
结论：颅内阳性表现提示术前感染状况明显活跃，但不影响术后病程。术前无脑并发症的患者可发生严重脑出血。尽管对所有IE患者的术前脑部并发症进行细致的检查是必不可少的，应该采取预防脑出血的策略，即使在没有颅内发现的患者中。
方法：2015年8月至2022年3月在我院接受治疗的32例急性IE患者中，有31例术前可进行颅内影像学评估，并与有和无颅内发现的患者进行比较。我们控制平均动脉血压和激活凝血时间（ACT），以防止体外循环（CPB）期间异常高的灌注压和ACT。术前背景，并对术后脑部并发症的术后疗程进行了回顾。
结果：在31例患者中，20例（65%）有术前影像学表现。有颅内发现的组明显年龄较大，其他器官有更多的栓塞，术中病理结果阳性，和更长的CPB时间。一名无颅内发现的患者术后出现新的脑出血。没有早期死亡；每组有两名患者反复感染，在有颅内发现的组中，有1人死于晚期脓毒症。
结论：颅内阳性表现提示术前感染状况明显活跃，但不影响术后病程。术前无脑并发症的患者可发生严重脑出血。尽管对所有IE患者的术前脑部并发症进行细致的检查是必不可少的，应该采取预防脑出血的策略，即使在没有颅内发现的患者中。
