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

Area of Science:

• Cardiology
• Neurosurgery
• Infectious Diseases

Background:

• The optimal timing for surgical intervention in patients with infective endocarditis and concomitant stroke is debated.
• Current guidelines often recommend delaying surgery for up to four weeks.
• However, urgent surgery may be necessary in cases of early heart failure or recurrent septic emboli.

Purpose of the Study:

• To evaluate the safety and outcomes of early versus delayed valve surgery in patients with infective endocarditis and preoperative neurological events.
• To determine if early surgical intervention is associated with adverse neurological or mortality outcomes.

Main Methods:

• A retrospective analysis of 688 patients surgically treated for left-sided infective endocarditis.
• 187 patients with preoperative neurological events were identified, with stroke onset documented in 147.
• Patients were stratified into an early surgery group (0-7 days) and a delayed surgery group (>7 days). Postoperative neurological status was assessed using the modified Rankin Scale.

Main Results:

• Preoperative sepsis was more common in patients with neurological complications (46.0% vs. 29.5%).
• Patients with hemorrhagic stroke were more likely to undergo delayed surgery (19.8% vs. 3.3%).
• Postoperative cerebrovascular accidents, neurological outcomes, and recovery rates were comparable between early and delayed surgery groups. In-hospital mortality and long-term survival did not differ significantly.

Conclusions:

• Early valve surgery in high-risk patients with infective endocarditis and stroke is a safe and viable option.
• Performing surgery within 7 days of stroke onset is not associated with worse neurological outcomes or survival compared to delayed surgery.