• Daisuke Yoshioka, Koichi Toda, Shuhei Okazaki, Taichi Sakaguchi, Shigeru Miyagawa, Yasushi Yoshikawa, OSCAR Study Group, and Yoshiki Sawa.
• Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. Electronic address: yoshioka@surg1.med.osaka-u.ac.jp.
• Ann. Thorac. Surg. 2015 Jul 1; 100 (1): 16-23.

BackgroundInfective endocarditis is often associated with cerebral complications, the most serious of which is intraoperative hemorrhagic stroke owing to anticoagulation for cardiopulmonary bypass. However, its prevalence and risk factors are unknown. We evaluated the prevalence and risk factors of intraoperative hemorrhagic stroke in patients with infective endocarditis.MethodsIn 246 patients who underwent valve surgery for active endocarditis between 2005 and 2012, 127 patients had both preoperative and postoperative intracranial neuroimaging. The prevalence and risk factors of intraoperative stroke were analyzed in those 127 patients.ResultsValve surgery was performed in 127 patients 19.6 ± 27.1 days after infective endocarditis diagnosis. Fourteen experienced intraoperative hemorrhagic stroke, and 1 died. None of 29 patients with preoperative hemorrhagic stroke showed exacerbation of hemorrhagic lesions, whereas 1 of 57 patients with preoperative cerebral infarction showed hemorrhagic transformation of infarct lesions. Thirteen of 14 hemorrhagic complications were new ectopic intracranial hemorrhage. Multivariate analysis showed not preoperative cerebral lesions but preoperative low hemoglobin level as the only risk factor for intraoperative hemorrhagic stroke (odds ratio, 0.51; 95% confidence interval, 0.26 to 0.87; p = 0.03). A preoperative hemoglobin cutoff value of 9.2 g/dL was determined by receiver operating curve analysis. Of 41 patients with preoperative hemoglobin level less than 9.2 g/dL, 9 (22%) had intraoperative new hemorrhage, whereas 4 (5%) of 86 patients with hemoglobin level of at least 9.2 g/dL had ectopic new hemorrhage.ConclusionsIntraoperative hemorrhagic stroke was not rare, and ectopic hemorrhagic stroke, associated with preoperative anemia, was more prevalent than hemorrhagic transformation of existing cerebral lesions.Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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