Early Valve Surgery for Endocarditis After Acute Embolic Stroke

Area of Science:

• Cardiology
• Neurosurgery
• Infectious Diseases

Background:

• Active infective endocarditis frequently causes acute stroke.
• Hemorrhagic conversion risk increases with valve repair/replacement.
• Optimal timing for surgical intervention remains debated.

Purpose of the Study:

• To evaluate the safety and outcomes of early valve surgery in patients with active infective endocarditis and acute stroke.
• To assess the impact of preoperative stroke on postoperative stroke incidence and hemorrhagic transformation.
• To determine if early surgery (≤72 hours) influences stroke risk.

Main Methods:

• Retrospective review of an institutional Society of Thoracic Surgeons database (2016-2024).
• Analysis of electronic medical records for stroke details and follow-up.
• Descriptive statistics and Kaplan-Meier survival curves for outcome evaluation.

Main Results:

• 656 patients underwent valve surgery for active endocarditis.
• 14.9% experienced preoperative stroke; 18.6% had microhemorrhagic and 12.2% had hemorrhagic strokes.
• Postoperative stroke incidence was 2.1% overall, with no significant difference between patients with or without preoperative stroke (4.1% vs 1.8%).
• Higher proportion of postoperative hemorrhagic strokes in the preoperative stroke group (3.1% vs 0.5%).
• Early surgery (≤72 hours) in patients with preoperative stroke was not associated with increased stroke risk (2.6% vs 5.0%).

Conclusions:

• Contemporary data support early valve surgery for acute endocarditis with acute stroke.
• This strategy demonstrates noninferior postoperative stroke risk.
• Early intervention is a feasible option, challenging previous concerns about operative timing.