PDF(Pubmed)
Abstract：
Stroke and intracranial hemorrhage (ICH) are serious complications that are difficult to manage during surgery for active infectious endocarditis (AIE). Relevant society guidelines still recommend delaying the cardiac surgery for AIE with ICH for 4 weeks. Some early studies indicated that the mortality rate decreases when cardiac surgery for ICH is delayed. In contrast, some reported that surgical intervention should not be delayed if an early operation is demanded, even in patients with ICH. The current literature on early vs. late surgery for infectious endocarditis (IE) with ICH is conflicting. Changing the cardiopulmonary bypass (CPB) strategy might be necessary to improve the surgical outcomes of IE with ICH. Some studies reported that cardiac surgery using nafamostat mesylate (NM) as an alternative anticoagulant during CPB was performed successfully. The combination of NM and low-dose heparin was beneficial for early surgery in patients with AIE complicated by cerebral infarction and ICH, without worsening cerebral lesions. In this report, we review and discuss the management of CPB in patients with ischemic and hemorrhagic stroke during surgery for AIE.
摘要：
中风和颅内出血（ICH）是严重的并发症，在活动性感染性心内膜炎（AIE）的手术过程中难以处理。相关社会指南仍建议将合并ICH的AIE的心脏手术推迟4周。一些早期研究表明，当ICH的心脏手术延迟时，死亡率会降低。相比之下,一些人报告说，如果需要早期手术，手术干预不应该推迟，即使是ICH患者。当前关于早期与感染性心内膜炎(IE)合并ICH的晚期手术治疗存在矛盾.改变体外循环（CPB）策略可能是必要的，以改善IE合并ICH的手术结果。一些研究报告说，在CPB期间成功地进行了使用甲磺酸Nafamostat（NM）作为替代抗凝剂的心脏手术。NM联合小剂量肝素对AIE合并脑梗死和ICH患者的早期手术有益。没有加重脑部病变。在这份报告中,我们回顾并讨论了在AIE手术期间缺血性和出血性卒中患者的CPB管理。
