title: Surgical Management of Infective Endocarditis Complicated by Embolic Stroke: Early versus Delayed Surgery.
abstract: BACKGROUND
  The optimal timing of surgery for infective endocarditis complicated by embolic stroke is unclear. We compared early versus delayed surgery in these patients.
  
  
  METHODS
  Between 1992 and 2007, 56 consecutive patients underwent open cardiac surgery for the treatment of infective endocarditis complicated by acute septic embolic stroke, 34 within 2 weeks (early group) and 22 more than 2 weeks (delayed group) after the onset of stroke.
  
  
  RESULTS
  The mean age at time of surgery was 45.7±14.8 years. Stroke was ischemic in 42 patients and hemorrhagic in 14. Patients in the early group were more likely to have highly mobile, large (>1 cm in diameter) vegetation and less likely to have hemorrhagic infarction than those in the delayed group. There were two (3.7%) intraoperative deaths, both in the early group and attributed to neurologic aggravation. Among the 54 survivors, 4 (7.1%), that is, 2 in each group, showed neurologic aggravation. During a median follow-up of 61.7 months (range, 0.4~170.4 months), there were 5 late deaths. Overall 5-year neurologic aggravation-free survival rates were 79.1±7.0% in the early group and 90.9±6.1% in the delayed group (p=0.113).
  
  
  CONCLUSIONS
  Outcomes of early operation for infective endocarditis in stroke patients were similar to those of the conventional approach. Early surgical intervention may be preferable for patients at high risk of life-threatening septic embolism.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.
authors.forename: Gwan Sic
authors.initials: GS
authors.lastname: Kim
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Yun
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee