title: Outcomes of early surgery for infective endocarditis with moderate cerebral complications.
abstract: We sought to clarify the effect of stroke severity on clinical outcomes in patients with infective endocarditis (IE) with cerebral complications and evaluate the impact of early surgery in the active phase on long-term prognosis in patients with nonsevere neurologic deficits.
  
  
  
  Clinical data were reviewed retrospectively in 170 consecutive patients with active left-sided IE with cerebral complications from 1990 to 2014. The mean age was 60 ± 17 years, and 93 (55%) were men. The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the severity of stroke. Major adverse cardiac events were defined as a composite of IE-related death, repeat surgery, and recurrence of IE.
  
  
  
  Baseline NIHSS score was associated strongly with clinical outcome. When patients were divided into 2 groups according to NIHSS, 33 patients had severe stroke (NIHSS ≥11) and 137 had nonsevere stroke (NIHSS ≤10); freedom from IE-related death and major adverse cardiac events was significantly lower in patients with severe stroke than in those with nonsevere stroke. Of 137 patients with nonsevere stroke, 65 underwent early surgery within 2 weeks of onset, and conventional treatment was applied in 72. Freedom from IE-related death was significantly greater in patients undergoing early surgery than in those on conventional treatment (P = .007). Moreover, adjusted survival analysis using the inverse probability treatment weighting method showed a significant beneficial effect of early surgery in reducing IE-related death (P = .012) in patients with nonsevere stroke.
  
  
  
  Early surgery might be beneficial in patients with nonsevere stroke.
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Murai
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Funakoshi
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. Electronic address: skaji@theia.ocn.ne.jp.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Kaji
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitai
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Kitae
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D000066491:Clinical Decision-Making; D004185:Disability Evaluation; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: infective endocarditis; stroke; surgery