Infective Endocarditis-Impact of Preoperative Neurological Complications on Postoperative Outcome

Treating infective endocarditis (IE) complicated by neurological events remains challenging and often requires case-by-case decisions. Identifying predictors of postoperative complications is key to effective risk assessment and management.

Data from 191 patients who underwent cardiac surgery for IE were analyzed. Patients were grouped based on the presence or absence of preoperative neurological events (ischemic stroke, TIA, or intracerebral hemorrhage). Univariate and multivariate logistic regression analyses were used to identify predictors of postoperative neurological complications.

Patients with preoperative neurological events underwent surgery later (33 ± 25 vs. 23 ± 23 days, p = 0.022), had larger vegetations (1.27 ± 1.88 vs. 0.68 ± 1.08 cm², p = 0.029), and more extracranial embolism (55% vs. 10%, p < 0.001). Patients with prior neurological complications developed more new cerebral embolic events (65% vs. 3.3%, p < 0.001), intracerebral bleeding (20% vs. 1.3%, p < 0.001), required longer ventilation (64 ± 89 vs. 59 ± 136 h, p = 0.013), and were more frequently discharged to neurological rehabilitation (26% vs. 9%, p = 0.008). Preexisting stroke or bleeding significantly increased the risk of cerebral embolism (OR 133.7), prolonged ventilation (OR 2.56), intracerebral bleeding (OR 420), and discharge to neurological rehabilitation (OR 4.71). Independent predictors of new postoperative neurological events were preoperative TIA (OR 19.45), cerebral embolism (OR 10.59), and leukocytosis (OR 8.36). Thirty-day mortality did not differ between groups (8.3% vs. 7.5%, p = 1.0).

Patients with preoperative neurological complications remain at high risk for neurological deterioration in the postoperative course.