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Early surgery for infective endocarditis with cerebral complications
International Journal of Cardiology 233 (2017) 99
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Early surgery for infective endocarditis with cerebral complications Funda Sungur Biteker a, Bülent Özlek b,⁎, Eda Özlek b, Nesrin Başaran c, Murat Biteker b a b c
Yatağan State Hospital, Department of Infectious Diseases and Clinical Microbiology, Turkey Muğla University, Faculty of Medicine, Department of Cardiology, Turkey Muğla University, Faculty of Medicine, Department of Pharmacology, Turkey
a r t i c l e
i n f o
Article history: Received 9 January 2017 Accepted 12 January 2017
We have greatly enjoyed reading the recently published article by Suzuki and colleagues [1]. The authors retrospectively evaluated clinical characteristics and outcomes in 68 consecutive patients with infective endocarditis (IE). Of the 68 patients 25 patients (37%) were complicated with cardioembolic stroke. When made a comparison between 19 with early cardiac surgery and 6 with conventional treatment in those with cardio-embolic strokes the authors found that in-hospital mortality was quite low in patients with early cardiac surgery compared to patients treated with conventional therapy. The effect of early surgery for IE with cerebral complications on clinical and neurologic outcomes, has not been clarified and which patients should undergo early surgery remains a conundrum [2]. Murai et al. very recently reviewed the data of 170 consecutive patients with active left-sided IE with cerebral complications [3]. The authors divided patients into 2 groups according to National Institutes of Health Stroke Scale (NIHSS) score; 33 patients had severe stroke (NIHSS ≥ 11) and 137 had nonsevere stroke (NIHSS ≤ 10). The results of this study
⁎ Corresponding author at: Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah, Haluk Özsoy Cad., 48000 Muğla, Turkey. E-mail address: [email protected] (B. Özlek).
http://dx.doi.org/10.1016/j.ijcard.2017.01.085 0167-5273/© 2017 Elsevier Ireland Ltd. All rights reserved.
revealed that in patients with nonsevere stroke, the survival rate in the early surgery group was significantly greater than that in the conventional treatment group; and patients complicated by severe stroke had a poor prognosis, regardless of the treatment strategy [3]. These findings suggest that early surgical intervention within 2 weeks may further improve clinical outcomes, with acceptable mortality and neurologic prognosis in patients with active IE complicated by nonsevere stroke. Therefore, we think that reanalysis of the data by Suzuki and colleagues according to the stroke severity may provide valuable information. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] M. Suzuki, S. Takanashi, Y. Ohshima, Y. Nagatomo, A. Seki, I. Takamisawa, et al., Critical potential of early cardiac surgery for infective endocarditis with cardio-embolic strokes, Int. J. Cardiol. 227 (Jan 15 2017) 222–224. [2] F.S. Biteker, Ö. Başaran, V. Doğan, M. Biteker, What is the optimal timing for surgical treatment of infective endocarditis? Mayo Clin. Proc. 90 (3) (Mar 2015) 415. [3] R. Murai, S. Funakoshi, S. Kaji, T. Kitai, K. Kim, T. Koyama, Y. Furukawa, Outcomes of early surgery for infective endocarditis with moderate cerebral complications, J. Thorac. Cardiovasc. Surg. S0022–5223 (16) (Nov 16 2016) 31481–31487.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Early surgery for infective endocarditis with cerebral complications Funda Sungur Biteker a, Bülent Özlek b,⁎, Eda Özlek b, Nesrin Başaran c, Murat Biteker b a b c
Yatağan State Hospital, Department of Infectious Diseases and Clinical Microbiology, Turkey Muğla University, Faculty of Medicine, Department of Cardiology, Turkey Muğla University, Faculty of Medicine, Department of Pharmacology, Turkey
a r t i c l e
i n f o
Article history: Received 9 January 2017 Accepted 12 January 2017
We have greatly enjoyed reading the recently published article by Suzuki and colleagues [1]. The authors retrospectively evaluated clinical characteristics and outcomes in 68 consecutive patients with infective endocarditis (IE). Of the 68 patients 25 patients (37%) were complicated with cardioembolic stroke. When made a comparison between 19 with early cardiac surgery and 6 with conventional treatment in those with cardio-embolic strokes the authors found that in-hospital mortality was quite low in patients with early cardiac surgery compared to patients treated with conventional therapy. The effect of early surgery for IE with cerebral complications on clinical and neurologic outcomes, has not been clarified and which patients should undergo early surgery remains a conundrum [2]. Murai et al. very recently reviewed the data of 170 consecutive patients with active left-sided IE with cerebral complications [3]. The authors divided patients into 2 groups according to National Institutes of Health Stroke Scale (NIHSS) score; 33 patients had severe stroke (NIHSS ≥ 11) and 137 had nonsevere stroke (NIHSS ≤ 10). The results of this study
⁎ Corresponding author at: Mugla Sitki Kocman Universitesi Tip Fakultesi, Orhaniye Mah, Haluk Özsoy Cad., 48000 Muğla, Turkey. E-mail address: [email protected] (B. Özlek).
http://dx.doi.org/10.1016/j.ijcard.2017.01.085 0167-5273/© 2017 Elsevier Ireland Ltd. All rights reserved.
revealed that in patients with nonsevere stroke, the survival rate in the early surgery group was significantly greater than that in the conventional treatment group; and patients complicated by severe stroke had a poor prognosis, regardless of the treatment strategy [3]. These findings suggest that early surgical intervention within 2 weeks may further improve clinical outcomes, with acceptable mortality and neurologic prognosis in patients with active IE complicated by nonsevere stroke. Therefore, we think that reanalysis of the data by Suzuki and colleagues according to the stroke severity may provide valuable information. Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] M. Suzuki, S. Takanashi, Y. Ohshima, Y. Nagatomo, A. Seki, I. Takamisawa, et al., Critical potential of early cardiac surgery for infective endocarditis with cardio-embolic strokes, Int. J. Cardiol. 227 (Jan 15 2017) 222–224. [2] F.S. Biteker, Ö. Başaran, V. Doğan, M. Biteker, What is the optimal timing for surgical treatment of infective endocarditis? Mayo Clin. Proc. 90 (3) (Mar 2015) 415. [3] R. Murai, S. Funakoshi, S. Kaji, T. Kitai, K. Kim, T. Koyama, Y. Furukawa, Outcomes of early surgery for infective endocarditis with moderate cerebral complications, J. Thorac. Cardiovasc. Surg. S0022–5223 (16) (Nov 16 2016) 31481–31487.