Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke
Kremer J, Jahn J, Klein S, Farag M, Borst T, Karck M (2023)
Publication Type: Journal article
Publication year: 2023
Journal
Book Volume: 10
Article Number: 356
Journal Issue: 8
DOI: 10.3390/jcdd10080356
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.
Involved external institutions
Germany (DE)How to cite
APA:
Kremer, J., Jahn, J., Klein, S., Farag, M., Borst, T., & Karck, M. (2023). Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke. Journal of Cardiovascular Development and Disease, 10(8). https://dx.doi.org/10.3390/jcdd10080356
MLA:
Kremer, Jamila, et al. "Early versus Delayed Surgery in Patients with Left-Sided Infective Endocarditis and Stroke." Journal of Cardiovascular Development and Disease 10.8 (2023).
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