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Influence of Stroke on Surgical Timing
Risk of neurological deterioration in case of symptomatic brain infarction (small, retrospective series) < 4 days: 20% 4-14 days: 20–50% 15-28 days: <10% >28 days: <1%
Conclusion: Surgery should be considered within the first 72 h if a patient with stroke has severe CHF, otherwise after 4 wks
Angstworm K, et al. J Neuro 2004
Multicenter prospective study of 496 consecutive IE patients Cerebrovascular complications in 22% of patients Neurological exacerbation in 6.3% (only in patients with symptomatic CVA) No excess surgical mortality with silent CVC or TIA
Conclusion: Safe to proceed to valve replacement despite transient ischemic attacks or ‘‘silent’’ cerebral embolism
Thuny F, et al. Eur Heart J 2007
Current Guidelines: Stroke and Surgery for Endocarditis
Amat-Santos IJ et al. Prosthetic valve endocarditis after transcatheter valve replacement JACC: Cardiovascular Interventions 8:2015
“Timing of surgery in patients with symptomatic ischemic stroke should be a balance of the severity of cardia decompensation and pathology and the severity
- f the neurological symptoms.
Patients with severe cardiac decompensation and severe mechanical cardiac lesions should be operated on emergently or urgently unless the neurological status (eg coma, large intracranial hemorrhage) precludes heparinization or when neurological recovery to reasonable quality of life is very unlikely (eg, multiple strokes or severe neurological deficits in patients with preexisting comorbidities. For patients with IE and parenchymal hemorrhage, it is reasonable to proceed for small lesions or to delay surgery, typically between 0 and 4 weeks, depending
- n the size of involvement and the urgency of the operations.”
Amat-Santos IJ et al. Prosthetic valve endocarditis after transcatheter valve replacement JACC: Cardiovascular Interventions 8:2015
Stroke and Surgery for Endocarditis in TAVR
CT
Cerebral
All patients at admission to detect cerebral infarction, hemorrhage, aneurysms
Abdominal
Uncontrolled infection or difficult situations, to detect visceral infarction, abscess or aneurysm
MRI
Cerebral
Better sensitivity for small cerebral infarctions and hemorrhages without radiation or contrast
Angiography
Cerebral
In patients with hemorrhage, suspicion of aneurysm with negative CT or MRI, or aneurysm detected on CT or MRI
PET/CT
Suspicion of prosthetic valve or pacemaker lead endocarditis with negative echo
Thuny F, et al. Imaging investigations in infective endocarditis: Current approach and perspectives. Arch Cardiovascular Dis, 2013
Beyond Echo: Imaging in IE
