Valve replacement in patients with endocarditis and acute neurologic deficit

Area of Science:

• Cardiology
• Neurology
• Infectious Diseases

Background:

• Acute neurologic deficits affect up to 40% of patients with left heart endocarditis.
• Management of neurologic dysfunction in endocarditis patients requiring valve operations is controversial.
• This study aimed to develop recommendations for evaluating and treating these patients.

Purpose of the Study:

• To analyze the outcomes of patients with left heart endocarditis and preoperative neurologic deficits.
• To establish guidelines for the evaluation and management of neurologic dysfunction in this patient population.
• To determine the optimal timing for cardiac operations in patients with endocarditis and neurologic deficits.

Main Methods:

• Retrospective review of 247 patients undergoing operations for left heart native valve endocarditis (1983-1995).
• Identification and analysis of 34 patients (14%) with preoperative neurologic deficits.
• Review of medical and pathology records, including diagnostic imaging (CT, MRI, angiography) and clinical outcomes.

Main Results:

• Embolic cerebrovascular accident was the most common cause of neurologic dysfunction (68%).
• Computed tomography (CT) was effective in identifying structural lesions (29/32 patients).
• Delaying cardiac operations by 2-3 weeks resulted in a 6% hospital mortality and 6% new/worse neurologic deficits.

Conclusions:

• Neurologic deficits are frequent in endocarditis patients undergoing cardiac operations.
• Delaying surgery for 2-3 weeks is generally well-tolerated and improves outcomes.
• CT is the preferred preoperative imaging; angiography is reserved for cases with suspected hemorrhage.