Early versus delayed surgery in patients with left-sided infective endocarditis and stroke

• Verfasst von: Kremer, Jamila [VerfasserIn]
• Verfasst von: Jahn, Joshua [VerfasserIn]
• Verfasst von: Klein, Sabrina [VerfasserIn]
• Verfasst von: Farag, Mina [VerfasserIn]
• Verfasst von: Borst, Tobias [VerfasserIn]
• Verfasst von: Karck, Matthias [VerfasserIn]
• Titel: Early versus delayed surgery in patients with left-sided infective endocarditis and stroke
• Verf.angabe: Jamila Kremer, Joshua Jahn, Sabrina Klein, Mina Farag, Tobias Borst, Matthias Karck
• E-Jahr: 2023
• Jahr: 21 August 2023
• Umfang: 12 S.
• Fussnoten: Gesehen am 02.11.2023
• Titel Quelle: Enthalten in: Journal of cardiovascular development and disease
• Ort Quelle: Basel : MDPI AG, 2014
• Jahr Quelle: 2023
• Band/Heft Quelle: 10(2023), 8, Artikel-ID 356, Seite 1-12
• ISSN Quelle: 2308-3425
• DOI: doi:10.3390/jcdd10080356
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: aortic valve
• Sach-SW: cerebral embolism
• Sach-SW: heart failure
• Sach-SW: infective endocarditis (IE)
• Sach-SW: intracranial haemorrhage
• Sach-SW: neurological complications
• Sach-SW: stroke
• Sach-SW: timing of surgery
• Sach-SW: valve surgery
• K10plus-PPN: 1869002059

Abstract

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.