Early Operation for Endocarditis Complicated by Preoperative Cerebral Emboli Is Not Associated With Worsened Outcomes

Abstract

Valve operations for patients presenting with infective endocarditis (IE) complicated by stroke are thought to carry elevated risk of postoperative complications. Our aim was to compare outcomes of IE patients who undergo surgical intervention early after diagnosis of septic cerebral emboli with outcomes of patients without preoperative emboli. All patients undergoing operations for left-sided IE between 1996 and 2013 at our institution were reviewed. Patients undergoing operations more than 14 days after embolic stroke diagnosis (n= 11) and those withpurely hemorrhagic lesions (n= 7) were excluded from the analysis. The study included 308 patients who were stratified according to the presence (STR, n= 54) or absence of a preoperative septic cerebral embolus (NoSTR, n= 254). Primary outcomes of interest were the development of a new postoperative stroke and 30-day mortality. Mean time to surgical intervention from stroke onset was 6.0 ± 4.1 days. Staphylococcus aureus(39% STR vs 21% NoSTR, p= 0.004) infection and annular abscess at operation (52% STR vs 27% NoSTR, p< 0.001) were more prevalent in STR patients. There wasno significant difference in 30-day mortality (9.3% STR vs 7.1% NoSTR, p= 0.57) or in the rate of new postoperative stroke (5 [9.4%] STR vs 12 [4.7%] NoSTR, p= 0.19) between groups. In addition, there was no difference in 10-year survival between groups (log-rank p= 0.74). Early surgical intervention in patients with IE complicated by preoperative septic cerebral emboli does not lead to significantly worse postoperative outcomes. Early surgical intervention for IE after embolic stroke warrants consideration, particularly in patients with high-risk features such as S aureus or annular abscess, or both.