title: Early Operation for Endocarditis Complicated by Preoperative Cerebral Emboli Is Not Associated With Worsened Outcomes.
abstract: BACKGROUND
  Valve operations for patients presenting with infective endocarditis (IE) complicated by stroke are thought to carry elevated risk of postoperative complications. Our aim was to compare outcomes of IE patients who undergo surgical intervention early after diagnosis of septic cerebral emboli with outcomes of patients without preoperative emboli.
  
  
  METHODS
  All patients undergoing operations for left-sided IE between 1996 and 2013 at our institution were reviewed. Patients undergoing operations more than 14 days after embolic stroke diagnosis (n = 11) and those with purely hemorrhagic lesions (n = 7) were excluded from the analysis. The study included 308 patients who were stratified according to the presence (STR, n = 54) or absence of a preoperative septic cerebral embolus (NoSTR, n = 254). Primary outcomes of interest were the development of a new postoperative stroke and 30-day mortality.
  
  
  RESULTS
  Mean time to surgical intervention from stroke onset was 6.0 ± 4.1 days. Staphylococcus aureus (39% STR vs 21% NoSTR, p = 0.004) infection and annular abscess at operation (52% STR vs 27% NoSTR, p < 0.001) were more prevalent in STR patients. There was no significant difference in 30-day mortality (9.3% STR vs 7.1% NoSTR, p = 0.57) or in the rate of new postoperative stroke (5 [9.4%] STR vs 12 [4.7%] NoSTR, p = 0.19) between groups. In addition, there was no difference in 10-year survival between groups (log-rank p = 0.74).
  
  
  CONCLUSIONS
  Early surgical intervention in patients with IE complicated by preoperative septic cerebral emboli does not lead to significantly worse postoperative outcomes. Early surgical intervention for IE after embolic stroke warrants consideration, particularly in patients with high-risk features such as S aureus or annular abscess, or both.
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorabella
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Han
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Mark
authors.initials: M
authors.lastname: Grbic
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Yeu Sanz
authors.initials: YS
authors.lastname: Wu
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takyama
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurlansky
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Michal A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Michael
authors.initials: M
authors.lastname: Argenziano
authors.affiliation: Division of Infectious Diseases, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gordon
authors.affiliation: Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: ig2006@cumc.columbia.edu.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061345:Early Medical Intervention; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000382:microbiology; D016896:Treatment Outcome; D055815:Young Adult