Early Surgery for Infective Endocarditis Complicated With Neurologic Injury

Abstract

ObjectivesTo estimate the association between early surgery and the risk of mortality in patients with left-sided infective endocarditis patients in the context of stroke. DesignRetrospective cohort study. SettingThis study was a multi-institution study based on Chang Gung Research Database (CGRD), which contains electronic medical records from 7 hospitals in northern and southern Taiwan; these include 2 medical centers, 2 regional hospitals, and 3 district hospitals. ParticipantsPatients with active left-sided infective endocarditis who underwent valve surgery between September 2002 and December 2018. InterventionsWe divided patients into two groups with versus without preoperative neurologic complications, undergone early (within 7 days) or non-early surgery, and with brain ischemia or hemorrhage. Measurements and Main Results392 patients with the median time from diagnosis to operation 6 days were included. No significant differences in postoperative stroke, in-hospital mortality, or follow-up outcomes were observed between the patients with and without neurological complications. Among the patients with preoperative neurological complications, patients who underwent early surgery had a lower 30-day postoperative mortality rate (13.1% vs 25.8%; hazard ratio, 0.21; 95% CI, 0.07 to 0.67). In the subgroup analysis of comparison between brain ischemia and hemorrhage groups, there was no significant between-group difference on the in-hospital outcomes or outcomes after discharge. ConclusionsEarly cardiac operation may be associated with more favorable clinical outcomes in the patients with preoperative neurological complications. Thus, preoperative neurological complications should not delay operative interventions.