Early versus delayed surgery in patients with left-sided infective endocarditis and stroke
Background: Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery...
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| Main Authors: | , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
21 August 2023
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| In: |
Journal of cardiovascular development and disease
Year: 2023, Volume: 10, Issue: 8, Pages: 1-12 |
| ISSN: | 2308-3425 |
| DOI: | 10.3390/jcdd10080356 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3390/jcdd10080356 Verlag, kostenfrei, Volltext: https://www.mdpi.com/2308-3425/10/8/356 
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| Author Notes: | Jamila Kremer, Joshua Jahn, Sabrina Klein, Mina Farag, Tobias Borst, Matthias Karck |
| Summary: | Background: Timing of surgery remains controversial in patients with infective endocarditis and stroke. Guidelines on infective endocarditis suggest delaying surgery for up to 4 weeks. However, with early heart failure due to progression of the infection or recurrent septic embolism, urgent surgery becomes imperative. Methods: Out of 688 patients who were surgically treated for left-sided infective endocarditis, 187 presented with preoperative neurological events. The date of cerebral stroke onset was documented in 147 patients. The patients were stratified according to timing of surgery: 61 in the early group (0-7 days) vs. 86 in the delayed group (>7 days). Postoperative neurological outcome was assessed by the modified Rankin Scale. Results: Preoperative sepsis was more prevalent in patients with preoperative neurological complications (46.0% vs. 29.5%, p < 0.001). Patients with haemorrhagic stroke were operated on later (19.8% vs. 3.3%, p = 0.003). Postoperative cerebrovascular accidents were comparable between both groups (p = 0.13). Overall, we observed good neurological outcomes (p = 0.80) and a high recovery rate, with only 5% of cases showing neurological deterioration after surgery (p = 0.29). In-hospital mortality and long-term survival were not significantly different in the early and delayed surgery groups (log-rank, p = 0.22). Conclusions: Early valve surgery in high-risk patients with infective endocarditis and stroke can be performed safely and is not associated with worse outcomes. |
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| Item Description: | Gesehen am 02.11.2023 |
| Physical Description: | Online Resource |
| ISSN: | 2308-3425 |
| DOI: | 10.3390/jcdd10080356 |