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Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe

Mehrdad Ghoreishi1, Nate Foster1, Chetan Pasrija1

  • 1Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland.

The Annals of Thoracic Surgery
|November 15, 2017
PubMed
Abstract

Insights

Preoperative stroke in mitral valve infective endocarditis patients does not increase the risk of postoperative stroke. Early surgery for mitral valve infective endocarditis with stroke is safe and recommended.

Area of Science:

  • Cardiology
  • Neurology
  • Infectious Diseases

Background:

  • Mitral valve (MV) infective endocarditis (IE) can lead to embolic stroke.
  • The risk of postoperative stroke after MV surgery in IE patients with preoperative stroke is not well-defined.

Purpose of the Study:

  • To investigate the association between preoperative embolic stroke and postoperative stroke risk in patients undergoing early surgery for active MV IE.

Main Methods:

  • A cohort of 243 patients undergoing surgery for active MV IE between 2003 and 2015 was analyzed.
  • Patients were divided into two groups: those with and without preoperative stroke (clinical or radiographic).
  • Postoperative stroke and mortality were compared between groups using confirmed diagnoses via neuroimaging and neurological examination.

Main Results:

  • The rate of postoperative stroke was 4% overall and did not differ significantly between patients with (4%) and without (4%) preoperative stroke (p=0.9).
  • Operative mortality was also similar between groups (7% with preoperative stroke vs. 7% without, p=0.9).
  • 33% of patients with stroke were asymptomatic preoperatively, identified only by imaging.

Conclusions:

  • Early surgical intervention for MV IE complicated by acute stroke is associated with a low risk of postoperative neurologic complications.
  • The presence of preoperative stroke does not appear to increase the risk of postoperative stroke, supporting timely surgical management.

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