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DOI: 10.1055/s-0032-1332555
The impact of preoperative limb embolisation in active infective left-sided endocarditis
Objective: Active infective endocarditis (AIE) is a life-threatening disease showing a variety of preoperative embolisation rates for different organ systems such as brain, spleen, kidneys and limbs. This study focused on the impact of preoperative limb embolisation in AIE undergoing valve surgery.
Methods: Between October 1994 and December 2011 a total number of 1.523 patients underwent valve surgery due to AIE at our institution. In total 94.9% (n = 1.446) of the patients suffered from left-sided AIE affecting aortic (n = 710) and mitral valve (n = 474) exclusively. Patient's characteristics, intra- and post-operative parameters were collected and evaluated. Retrospective analyses were performed for preoperative embolisation, need for intervention and 30-day mortality rate.
Results: General preoperative embolisation was observed in n = 670 patients (45.8%) mostly affecting spleen (29.9%), brain (24.5%) and kidneys (11.3%). Limb embolisation, however was observed in 90 individuals (6.2%). In these patients interventions due to septembolic events were necessary in 14 individuals (15.5%) before valve surgery: embolectomy in 8, rotablation in 1, amputation in 5. Over all 30-day mortality rate for this 90 individuals was 21.1% (n = 19); none of the 14 individuals with need for intervention died perioperatively after valve surgery.
Conclusion: Peripheral limb embolisation is a rare complication due to left-sided AIE, which needs emergence treatment including amputation. This aggressive treatment option does not increase 30-day mortality after valve surgery and should therefore be considered if necessary.