title: Reconstructive valve surgery within 10 days of stroke in endocarditis.
abstract: BACKGROUND
  The optimal timing of surgical treatment for infective endocarditis complicated by cerebrovascular events is controversial, largely due to the perceived risk of perioperative intracranial bleeding. Current guidelines suggest waiting 2 weeks between the diagnosis of stroke and surgery. The aim of this study was to investigate the clinical and neurological outcomes of early surgery following a stroke.
  
  
  METHODS
  This was a single-center retrospective analysis of 12 consecutive patients requiring surgery for infective endocarditis between 2011 and 2014 at Rush University Medical Center, with either ischemic (n = 6) and/or hemorrhagic (n = 6) cerebrovascular complications. All underwent computed tomographic angiography prior to early valve reconstructive surgery to identify potentially actionable neurological findings. Early valve surgery was performed for ongoing sepsis or persistent emboli. Neurologic risk and outcome were assessed pre- and postoperatively using the National Institutes of Health Stroke Scale and the Glasgow Outcome Scale, respectively.
  
  
  RESULTS
  All 12 patients underwent surgical treatment within 10 days of the diagnosis of stroke. Mortality in the immediate postoperative period was 8%. Eleven of the 12 patients exhibited good neurological recovery in the immediate postoperative period, with a Glasgow Outcome Scale score ≥ 3. There was no correlation between duration of cardiopulmonary bypass and neurological outcomes.
  
  
  CONCLUSIONS
  Early cardiac surgery in patients with infective endocarditis and stroke maybe lifesaving with a low neurological risk. Comprehensive neurovascular imaging may help in identifying patient-related risk factors.
authors.affiliation: Division of Cardiac Surgery, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA ramanj@ohsu.edu.
authors.forename: Jai
authors.initials: J
authors.lastname: Raman
authors.affiliation: Department of Medicine, Royal Alexandra Hospital, UK.
authors.forename: Apoorva
authors.initials: A
authors.lastname: Ballal
authors.affiliation: Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA.
authors.forename: Bala
authors.initials: B
authors.lastname: Hota
authors.affiliation: Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Mirza
authors.affiliation: National University of Singapore, Singapore.
authors.forename: David
authors.initials: D
authors.lastname: Lai
authors.affiliation: Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bleck
authors.affiliation: Department of Medicine, Rush University Medical Center, Chicago, IL Illinois, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Lateef
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002533:Cerebral Angiography / Q000379:methods; D002641:Chicago; D000072226:Computed Tomography Angiography; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D023261:Glasgow Outcome Scale; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006351:Heart Valves / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Cerebral infarction; Endocarditis; Heart valve diseases; Intracranial hemorrhages; Stroke; Time factors; bacterial