Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke.
BACKGROUND
The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities.


METHODS
Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates.


RESULTS
Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308; 95% confidence interval [CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328; adjusted hazard ratio, 1.138; 95% CI, .802-1.650).


CONCLUSIONS
There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.
Hospital for Infectious Diseases, School of Medicine, Zagreb, Croatia. bbarsic@bfm.hr
Bruno
B
Barsic
Stuart
S
Dickerman
Vladimir
V
Krajinovic
Paul
P
Pappas
Javier
J
Altclas
Giampiero
G
Carosi
José H
JH
Casabé
Vivian H
VH
Chu
Francois
F
Delahaye
Jameela
J
Edathodu
Claudio Querido
CQ
Fortes
Lars
L
Olaison
Ana
A
Pangercic
Mukesh
M
Patel
Igor
I
Rudez
Syahidah Syed
SS
Tamin
Josip
J
Vincelj
Arnold S
AS
Bayer
Andrew
A
Wang
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D015331:Cohort Studies; D004696:Endocarditis / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000401:mortality*; D013997:Time Factors