Neurological Complications in Surgical Patients with Left-Sided Infective Endocarditis: Risk Factors, Prognosis, and...

Area of Science:

• Cardiology
• Neurology
• Infectious Diseases

Background:

• Left-sided valvular infective endocarditis (IE) poses significant risks, particularly when complicated by preoperative neurological issues.
• Understanding these complications is vital for surgical decision-making and patient outcomes.

Purpose of the Study:

• To investigate baseline characteristics, risk factors, and prognosis of surgical IE patients with preoperative neurological complications.
• To assess the impact of neurological complication subtypes and surgical timing on outcomes.

Main Methods:

• Retrospective analysis of 605 surgical IE patients (May 2012-June 2024).
• Propensity score matching (PSM) for 1:1 comparison of complication vs. non-complication groups.
• Analysis of neurological complication subtypes, surgical timing (early/delayed), risk factors, and prognosis using regression and survival analyses.

Main Results:

• Neurological complications occurred in 27.8% of patients, with mitral valve involvement and mobile vegetations as key risk factors.
• While overall mortality was similar between groups post-PSM, neurological complications increased the risk of new-onset cerebral events.
• Cerebral hemorrhage predicted in-hospital mortality; early surgery for infarction correlated with higher complication rates.

Conclusions:

• Neurological complications in IE increase postoperative neurological deterioration risk but not overall mortality, except for cerebral hemorrhage and regional infarction.
• Risk factors include mitral valve disease, mobile vegetations, and preoperative emboli.
• Individualized surgical timing is recommended, especially considering the impact of early surgery on infarction patients.