title: Stroke is not a treatment dilemma for early valve surgery in active infective endocarditis.
abstract: OBJECTIVE
  While early valve surgery for active infective endocarditis (AIE) is recommended, surgeons have hesitated to operate on patients complicated by cerebral septic embolism resulting in cerebral bleeding when cardiopulmonary bypass is required intraoperatively. The study aim was to review the outcomes of operations for AIE, and to determine the risks of neurologic complications resulting from cerebral septic embolism.
  
  
  METHODS
  Between 1994 and June 2011, among 278 patients who underwent heart valve surgery for AIE at the authors' institution, 39 (14%) had cerebral septic embolisms. Cerebral lesions were verified by imaging, and were predominantly multiple embolic infarctions (34 patients; 87.2%). Five patients had brain abscess, and 10 had hemorrhage with or without infarction. The mean interval between the recent onset of a stroke and surgery was 10.1 ± 10.1 days (range: 0-43 days).
  
  
  RESULTS
  One patient died postoperatively of septic shock. New neurologic complications occurred in five patients, including secondary hemorrhagic transformation in the previous lesions (n = 2), newly developed subdural and subarachnoid hemorrhage (n = 2), and an increased degree of subarachnoid hemorrhage (n = 1). One patient needed a craniotomy, and the others were treated medically. There were five late deaths, including one cardiac death, and one redo valve surgery due to repaired valve failure during the follow up period of 46.3 ± 40.4 months (range: 1.9-127.4 months). The overall and event-free survival rates at five and 10 years were 84.3 ± 6.5% and 75.9 ± 9.9%, and 81.7 ± 6.8% and 73.6 ± 9.9%, respectively.
  
  
  CONCLUSIONS
  Surgery for AIE with cerebral septic embolisms can be performed safely, with good early and mid-term follow-up results. When urgent or emergent surgery for AIE is needed, neurologic complications should not be a reason for delay.
authors: Su
authors: S
authors: Wan
authors: Kiick
authors: K
authors: Sung
authors: Pyo Won
authors: PW
authors: Park
authors: Wook Sung
authors: WS
authors: Kim
authors: Young Tak
authors: YT
authors: Lee
authors: Tae-Gook
authors: TG
authors: Jun
authors: Ji-Hyuk
authors: JH
authors: Yang
authors: Dong Seop
authors: DS
authors: Jeong
authors: Yang Hyun
authors: YH
authors: Cho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000209:etiology; D020520:Brain Infarction / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult