(a) All patients (n = 438) No neurological complications preoperative (n = 349, 79.7%) Neurological complications preoperative (n = 89, 20.3%) valueAge, years 61.0 ± 14.9 61.0 ± 14.9 61.1 ± 15.0 0.964 64 (52; 73) 64 (52; 73) 64 (53; 74) Female gender 112 (25.6%) 82 (23.5%) 30 (33.7%) 0.049 Body mass index (kg/m2 ) 25.9 (23.0; 29.4) 26.1 (23.2; 29.8) 24.7 (22.6; 28.7) 0.122 Logistic EuroSCORE I 25.0 (11.0; 45.7) 24.2 (9.2; 44.9) 26.8 (15.9; 51.6) 0.042 EuroSCORE II 11.5 (4.5; 25.5) 11.8 (4.8; 26.0) 8.7 (3.9; 25.2) 0.353 COPD 55 (12.6%) 43 (12.3%) 12 (13.5%) 0.768 Arterial hypertension 257 (58.7%) 213 (61.0%) 44 (49.4%) 0.047 Ejection fraction (%) 55 (50; 56) 55 (48; 56) 55 (50; 60) 0.263 LVEF poor (<30) 40 (9.3%) 34 (10.0%) 6 (6.8%) 0.365 Atrial fibrillation 83 (18.9%) 61 (17.5%) 22 (24.7%) 0.120 Peripheral vascular disease 38 (8.7%) 30 (8.6%) 8 (9.0%) 0.906 Drug abuse 24 (5.5%) 18 (5.2%) 6 (6.7%) 0.601 Type 2 diabetes mellitus 88 (20.1%) 73 (20.9%) 15 (16.9%) 0.393 IDDM 51 (11.6%) 41 (11.7%) 10 (11.2%) 0.893 Immunosuppressive therapy 13 (3.0%) 7 (2.0%) 6 (6.7%) 0.030 Acute renal insufficiency 55 (12.6%) 35 (10.0%) 20 (22.5%) 0.002 Acute dialysis preoperative 27 (6.2%) 16 (4.6%) 11 (12.4%) 0.006 Chronic dialysis preoperative 19 (4.3%) 15 (4.3%) 4 (4.5%) 1.000 Chronic renal insufficiency 123 (28.1%) 101 (28.9%) 22 (24.7%) 0.429 NYHA stages 2 (2; 3) 2 (2; 3) 2 (2; 3) 0.340 NYHA IV 88 (20.2%) 71 (20.5%) 17 (19.1%) 0.785 Coronary heart disease 186 (42.5%) 151 (43.3%) 35 (39.3%) 0.502 State after PCI 39 (8.9%) 31 (8.9%) 8 (9.0%) 0.975 Previous cardiac surgery 181 (41.3%) 157 (45.0%) 24 (27.0%) 0.002 CABG 11 (2.6%) 10 (3.0%) 1 (1.2%) 0.474 Aortic valve replacement 70 (16.7%) 57 (17.1%) 13 (15.1%) 0.665 Mitral valve replacement/reconstruction 8 (1.9%) 7 (2.1%) 1 (1.2%) 1.000 Combined valve surgery 84 (20.0%) 76 (22.8%) 8 (9.3%) 0.005 TAVI 2 (0.5%) 2 (0.6%) 0 (0.0%) 1.000 Tumor 55 (12.6%) 41 (11.7%) 14 (15.7%) 0.311 (b) All patients (n = 438) No neurological complications preoperative (n = 349, 79.7%) Neurological complications preoperative (n = 89, 20.3%) valueAcute myocardial infarction (≤48 h) 14 (3.2%) 8 (2.3%) 6 (6.8%) 0.042 Cardiogenic shock 21 (4.8%) 19 (5.4%) 2 (2.2%) 0.274 CPR (≤48 h) 9 (2.1%) 8 (2.3%) 1 (1.1%) 0.694 Inotropic therapy 84 (19.2%) 61 (17.5%) 23 (25.8%) 0.074 Emergency 96 (21.9%) 74 (21.2%) 22 (24.7%) 0.474 Intensive care patient 96 (21.9%) 64 (18.3%) 32 (36.0%) <0.001 Intubated at admission 38 (8.7%) 27 (7.7%) 11 (12.4%) 0.167 Neurological complications 85 (19.4%) 0 (0.0%) 85 (95.5%) <0.001 Stroke 78 (17.8%) 0 (0.0%) 78 (87.6%) <0.001 TIA 7 (1.6%) 0 (0.0%) 7 (7.9%) <0.001 Silent cerebral embolization 4 (0.9%) 0 (0.0%) 4 (4.5%) 0.841 Preoperative embolization 123 (28.1%) 41 (11.7%) 82 (92.1%) <0.001 Cerebral 61 (13.9%) 0 (0.0%) 61 (68.5%) <0.001 Spleen 17 (3.9%) 17 (4.9%) 0 (0.0%) 0.030 Several organs 34 (7.8%) 14 (4.0%) 20 (22.5%) <0.001 Fever (≥38°C) before surgery 88 (20.1%) 72 (20.6%) 16 (18.0%) 0.577 Tumor 55 (12.6%) 41 (11.7%) 14 (15.7%) 0.311 Endocarditis experienced 63 (14.4%) 58 (16.6%) 5 (5.6%) 0.008 Time from diagnosis to surgery (days) 7 (2; 17) 8 (2; 17) 7 (3; 17) 0.851 Time from antibiotic start to surgery (days) 10 (3; 21) 10 (3; 21) 9 (4; 18) 0.826 (c) All patients (n = 438) No neurological complications preoperative (n = 349, 79.7%) Neurological complications preoperative (n = 89, 20.3%) valuePathogens Staphylococcus aureus 87 (20.0%) 56 (16.1%) 31 (35.2%) <0.001 Enterococcus 64 (14.7%) 56 (16.1%) 8 (9.0%) 0.089 Viridans streptococci 47 (10.8%) 40 (11.5%) 7 (7.9%) 0.320 Gram-positive streptococcus 39 (8.9%) 30 (8.6%) 9 (10.1%) 0.665 HACEK group 1 (0.2%) 1 (0.3%) 0 (0.0%) 0.612 Mycosis 6 (1.4%) 5 (1.4%) 1 (1.1%) 1.000 Culture negative 117 (26.8%) 94 (27.1%) 23 (25.8%) 0.813 Staphylococcus epidermidis 30 (6.9%) 26 (7.5%) 4 (4.5%) 0.319 MRSA 15 (3.4%) 10 (2.9%) 5 (5.6%) 0.201 Unknown 44 (10.1%) 38 (11.0%) 6 (6.7%) 0.240 Valve affection Number of affected valves 1 (1–3) 1 (1–3) 1 (1-2) 0.262 AV isolated 132 (30.1%) 102 (29.2%) 30 (33.7%) 0.411 AV combined 178 (40.6%) 138 (39.5%) 40 (44.9%) 0.354 AV + MV 38 (8.7%) 30 (8.6%) 8 (9.0%) 0.906 MV isolated 99 (22.6%) 69 (19.8%) 30 (33.7%) 0.005 MV + TV 2 (0.5%) 0 (0.0%) 2 (2.2%) 0.041 MV combined 137 (31.3%) 98 (28.1%) 39 (43.8%) 0.004 AV + TV 5 (1.1%) 4 (1.1%) 1 (1.1%) 1.000 AV + TV + MV 2 (0.5%) 2 (0.6%) 0 (0.0%) 1.000 TV isolated 9 (2.1%) 9 (2.6%) 0 (0.0%) 0.215 TV combined 18 (4.1%) 15 (4.3%) 3 (3.4%) 1.000 Prosthetic endocarditis isolated 149 (34.0%) 131 (37.5%) 18 (20.2%) 0.002 Prosthetic endocarditis combined 166 (37.9%) 144 (41.3%) 22 (24.7%) 0.004 TAVI 1 (0.2%) 1 (0.3%) 0 (0.0%) 1.000 Prosthetic endocarditis isolated 71 (16.2%) 61 (17.5%) 10 (11.2%) 0.154 Abscess 121 (27.6%) 101 (28.9%) 20 (22.5%) 0.223 Vegetation 315 (72.7%) 240 (69.8%) 75 (84.3%) 0.006 Vegetation size (mm) 13 (9; 19) 13 (8; 19) 15 (10; 20) 0.128 (d) All patients (n = 438) No neurological complications preoperative (n = 349, 79.7%) Neurological complications preoperative (n = 89, 20.3%) valueHemoglobin (g/dL) 10.3 (9.2; 11.7) 10.3 (9.2; 11.8) 10.0 (8.7; 11.5) 0.066 Hematocrit (%) 30.8 (27.6; 35.0) 31.0 (28.0; 35.0) 29.2 (26.7; 34.0) 0.007 Lactate (mmol/L) 0.8 (0.6; 1.1) 0.8 (0.6; 1.2) 0.7 (0.5; 0.9) 0.006 Potassium (mmol/L) 3.9 (3.6; 4.3) 3.9 (3.6; 4.3) 4.9 (4.5; 5.4) 0.768 CRP (mg/L) 40.9 (15.8; 86.8) 39.7 (16.5; 82.4) 47.5 (13.6; 94.2) 0.539 PCT (ng/mL) 0.24 (0.11; 0.67) 0.21 (0.10; 0.65) 0.28 (0.14; 0.83) 0.375 Creatinine (µ mol/L) 102 (76; 143) 103 (77; 141) 097 (71; 149) 0.782 GFR (ml/min) 61 (42; 68) 61 (42; 69) 61 (39; 64) 0.802 Leukocytes (109 /L) 8.70 (6.64; 11.36) 8.60 (6.64; 11.16) 9.29 (6.61; 12.69) 0.509 Platelets (109 /L) 238 (170; 313) 240 (171; 319) 219 (152; 301) 0.104 Urea (mmol/L) 5.8 (4.0; 10.0) 5.8 (3.9; 9.5) 6.0 (4.5; 11.4) 0.318 CK (U/L) 40 (26; 79) 41 (27; 81) 36 (23; 68) 0.143 CK-MB (U/L) 11.6 (7.8; 18.5) 11.5 (7.9; 17.1) 12.4 (7.4; 22.9) 0.793 AST/GOT (U/L) 29.1 (20.5; 48.0) 28.8 (20.0; 49.7) 30.6 (23.0; 42.8) 0.740 ALT/GPT (U/L) 22.1 (13.2; 37.8) 22.0 (13.2; 38.3) 23.0 (12.7; 37.0) 0.638 Bilirubin (µ mol/L) 9.4 (6.3; 15.0) 9.7 (6.6; 16.0) 8.0 (4.9; 13.4) 0.037 INR 1.16 (1.07; 1.30) 1.16 (1.06; 1.30) 1.17 (1.10; 1.31) 0.392
EuroSCORE, European System for Cardiac Operative Risk Evaluation; COPD, chronic obstructive pulmonary disease; LVEF, left ventricular ejection fraction; IDDM, insulin-dependent diabetes mellitus; NYHA IV, New York Heart Association heart failure stage IV; CABG, coronary artery bypass grafting; TAVI, transcatheter aortic valve implantation. CPR, cardiopulmonary resuscitation; TIA, transient ischemic attack. HACEK, Haemophilus , Aggregatibacter , Cardiobacterium , Eikenella , Kingella ; MRSA, methicillin-resistant Staphylococcus aureus ; AV, aortic valve; MV, mitral valve; TV, tricuspid valve; TAVI, transcatheter aortic valve implantation. CRP, C-reactive protein; GFR, glomerular filtration rate; CK, creatine kinase; INR, international normalized ratio.