title: Critical potential of early cardiac surgery for infective endocarditis with cardio-embolic strokes.
abstract: BACKGROUND
  Early cardiac surgery may have a trade-off between stabilized hemodynamics with controlled infection and a risk of peri-operative death in patients with infective endocarditis (IE) complicated with cardio-embolic strokes.
  
  
  METHODS
  We retrospectively studied clinical characteristics and outcomes in 68 consecutive patients with IE (mean age, 58±3years, 62% male) who admitted in our institute during June 2013 and August 2015.
  
  
  RESULTS
  Cardio-embolic strokes were noted in 37% of patients (n=25) with IE and overall in-hospital mortality was 4 times higher in IE with cardio-embolic strokes than IE with an absence of strokes (n=43) (20% vs. 4.7%, p=0.045). Bacteremia of Staphylococcus aureus (p=0.021) and a complication of cardio-embolic strokes (p=0.031) were independently associated with in-hospital death in those with IE. However, in-hospital mortality was quite low in 19 with early cardiac surgery compared with 6 with conventional treatment in those with cardio-embolic strokes (11% vs. 50%, p=0.035). Multivariate logistic analysis demonstrated that lack of early cardiac surgery (p=0.014), a complication of cerebral hemorrhage (p=0.002), and a presence of refractory heart failure (p=0.047) were independently associated with in-hospital death in those with IE complicated with cardio-embolic strokes.
  
  
  CONCLUSIONS
  Early cardiac surgery may provide clinical advantages overcoming peri-operative risks in those with IE complicated with cardio-embolic strokes.
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.. Electronic address: msuzuki@shi.heart.or.jp.
authors.forename: Makoto
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Department of Cardiovascular surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Ohshima
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nagatomo
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seki
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Itaru
authors.initials: I
authors.lastname: Takamisawa
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tobaru
authors.affiliation: Department of Cardiovascular surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Naito
authors.affiliation: Department of Cardiovascular surgery, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kin
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Umemura
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.affiliation: Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.
authors.forename: Hitonobu
authors.initials: H
authors.lastname: Tomoike
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D013997:Time Factors
keywords: Cardio-embolic strokes; Early cardiac surgery; In-hospital mortality; Infective endocarditis