Endocarditis, Neurologic Complication
Conditions
Brief summary
Surgical delay in severe endocardits, with neurological complications, is still debated. Early surgery, if indicated, permits to avoid new embolic events, or to fix valvular damages, but can create or increase a cerebral hemorrage. Hypothesis Cardiac surgery, as soon as possible, if indicated, would reduce mortality, in severe left endocarditis, with neurological complications. Primary objective To assess the impact of early versus late cardiac surgery on mortality at 1 year, in patients with severe endocarditis, with neurological complications. Primary endpoint: 1\) Mortality at 1 year Secondary endpoints: 1. Analyze the factors associated with neurological degradation 2. Evaluate the neurological tolerance of cardiac surgery.
Detailed description
Surgical delay in severe endocardits, with neurological complications, is still debated. Early surgery, if indicated, permits to avoid new embolic events, or to fix valvular damages, but can create or increase a cerebral hemorrage. Hypothesis Cardiac surgery, as soon as possible, if indicated, would reduce mortality, in severe left endocarditis, with neurological complications. Primary objective To assess the impact of early versus late cardiac surgery on mortality at 1 year, in patients with severe endocarditis, with neurological complications. Primary endpoint: 1\) Mortality at 1 year Secondary endpoints: 1. Analyze the factors associated with neurological degradation 2. Evaluate the neurological tolerance of cardiac surgery. Methods Multicentric study (7 French university hospitals). Retrospective study: from august 2010 to december 2017. Propensity score matching study. 192 patients are included.
Interventions
PROCEDURECardiac surgery
Cardiac surgery, if indicated, delayed or not by neurological complications
Sponsors
Gros, Alexandre, M.D.
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Inclusion criteria
* Left endocarditis * With indication of cardiac surgery * Severe endocaditis (SOFA score \> or = 3/16) * With pre operative neurological complications
Exclusion criteria
* Age \< 18 * Right endocarditis without left endocarditis * No severe endocarditis (SOFA score \< 3) * Ne pre operative neurological complications * Endocarditis without indication of cardiac surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mortality | at 1 year after the diagnosis of endocarditis | Death from any cause |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Neurogical tolerance | At 6 months | Modified Rankin score after cardiac surgery, 0 (no symptoms at all) to 6 (death) |
Outcome results
None listed