Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 21;10(8):356.
doi: 10.3390/jcdd10080356.

Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke

Jamila Kremer  1 , Joshua Jahn  1 , Sabrina Klein  2 , Mina Farag  1 , Tobias Borst  3 , Matthias Karck  1
Affiliations

Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke

Jamila Kremer et al. J Cardiovasc Dev Dis. .

Abstract

Background: Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes imperative.

Methods: Out of 688 patients who were surgically treated for left-sided infective endocarditis, 187 presented with preoperative neurological events. The date of cerebral stroke onset was documented in 147 patients. The patients were stratified according to timing of surgery: 61 in the early group (0-7 days) vs. 86 in the delayed group (>7 days). Postoperative neurological outcome was assessed by the modified Rankin Scale.

Results: Preoperative sepsis was more prevalent in patients with preoperative neurological complications (46.0% vs. 29.5%, p < 0.001). Patients with haemorrhagic stroke were operated on later (19.8% vs. 3.3%, p = 0.003). Postoperative cerebrovascular accidents were comparable between both groups (p = 0.13). Overall, we observed good neurological outcomes (p = 0.80) and a high recovery rate, with only 5% of cases showing neurological deterioration after surgery (p = 0.29). In-hospital mortality and long-term survival were not significantly different in the early and delayed surgery groups (log-rank, p = 0.22).

Conclusions: Early valve surgery in high-risk patients with infective endocarditis and stroke can be performed safely and is not associated with worse outcomes.

Keywords: aortic valve; cerebral embolism; heart failure; infective endocarditis (IE); intracranial haemorrhage; neurological complications; stroke; timing of surgery; valve surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of patient selection. IE: infective endocarditis.
Figure 2
Figure 2
Neurological recovery in early vs. delayed surgery groups after preoperative stroke assessed by changes in pre- to postoperative mRS. mRS: modified Rankin Scale; *: available data (n = 109).
Figure 3
Figure 3
Kaplan–Meier survival analysis of early vs. delayed surgery after preoperative stroke. Early surgery (blue line) vs. delayed surgery (red line).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Zhang L.Q., Cho S.-M., Rice C.J., Khoury J., Marquardt R.J., Buletko A.B., Hardman J., Wisco D., Uchino K. Valve surgery for infective endocarditis complicated by stroke: Surgical timing and perioperative neurological complications. Eur. J. Neurol. 2020;27:2430–2438. doi: 10.1111/ene.14438. - DOI - PubMed
    1. Heiro M., Helenius H., Hurme S., Savunen T., Engblom E., Nikoskelainen J., Kotilainen P. Short-term and one-year outcome of infective endocarditis in adult patients treated in a Finnish teaching hospital during 1980–2004. BMC Infect. Dis. 2007;7:78. doi: 10.1186/1471-2334-7-78. - DOI - PMC - PubMed
    1. Thuny F., Avierinos J.-F., Tribouilloy C., Giorgi R., Casalta J.-P., Milandre L., Brahim A., Nadji G., Riberi A., Collart F., et al. Impact of cerebrovascular complications on mortality and neurologic outcome during infective endocarditis: A prospective multicentre study. Eur. Heart J. 2007;28:1155–1161. doi: 10.1093/eurheartj/ehm005. - DOI - PubMed
    1. García-Cabrera E., Fernández-Hidalgo N., Almirante B., Ivanova-Georgieva R., Noureddine M., Plata A., Lomas J.M., Gálvez-Acebal J., Hidalgo-Tenorio C., Ruíz-Morales J., et al. Neurological complications of infective endocarditis: Risk factors, outcome, and impact of cardiac surgery: A multicenter observational study. Circulation. 2013;127:2272–2284. doi: 10.1161/CIRCULATIONAHA.112.000813. - DOI - PubMed
    1. Habib G., Lancellotti P., Antunes M.J., Bongiorni M.G., Casalta J.-P., Del Zotti F., Dulgheru R., El Khoury G., Erba P.A., Iung B., et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) Eur. Heart J. 2015;36:3075–3128. doi: 10.1093/eurheartj/ehv319. - DOI - PubMed

LinkOut - more resources