Patients with active endocarditis often suffer acute stroke, with increased risk for hemorrhagic conversion at the time of valve repair or replacement. Controversy persists as to timing of operative intervention. An institutional Society of Thoracic Surgeons database of all patients with endocarditis was reviewed for patients undergoing valve surgery (2016-24). Electronic medical records were reviewed for detailed stroke information and longitudinal follow-up. Descriptive statistics and Kaplan Meier Survival Curves evaluated outcomes and survival. A total of 656 patients underwent surgery for acute active infective endocarditis. A total of 98 (14.9%) patients had preoperative stroke, 86 (87.8%) embolic of which 16 (18.6%) had micro-hemorrhage and 12 (12.2%) with hemorrhagic strokes. Median time between preoperative stroke diagnosis and surgery was 5.5 days. The overall incidence of postoperative stroke was 2.1% (14/646), with no statistically significant difference in postoperative stroke between patients with vs without preoperative stroke (n=4/98, 4.1% vs n=10/558, 1.8%; p=0.148). However, there was a higher proportion of patients with postoperative hemorrhagic strokes in the preoperative stroke group (3.1% vs 0.5%, p=0.016). Finally, of patients with preoperative stroke early surgery (72 hours n= 38 (38.8%)) was not associated with increased stroke (2.6% vs 5.0%, p=0.564). These contemporary data highlight the feasibility of an early valve surgery strategy for acute endocarditis in the setting of acute stroke, with non-inferior postoperative stroke risk.