Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients.

Abstract

Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome. We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses. Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2%) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1±2.6 vs. 6.6±3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17%) and septic shock (37 vs. 19%). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1% vs. 45%, p=0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58%, p=0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis. Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.