Infective endocarditis and neurologic events: indications and timing for surgical interventions

Author:

Bonaros Nikolaos1,Czerny Martin2,Pfausler Bettina3,Müller Silvana4,Bartel Thomas5,Thielmann Matthias6,Shehada Sharaf-Eldin6,Folliguet Thierry7,Obadia Jean-Francois8,Holfeld Johannes1,Lorusso Roberto9,Parolari Alessandro10,Müller Ludwig1,Grimm Michael1,Ruttmann-Ulmer Elfriede1

Affiliation:

1. Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria

2. University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany

3. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

4. Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria

5. Department of Cardiology Mediclinic City, Hospital Dubai, Dubai, United Arab Emirates

6. Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany

7. Department of Cardiac Surgery and Transplantation, Henry Mondor Hospital, Paris, France

8. Department of Cardiac Surgery and Transplantation, Louis Pradel Hospital, Lyon, France

9. Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maaastricht, The Netherlands

10. Department of Cardiac Surgery, San Donato Hospital, IRCCS, Milan, Italy

Abstract

Abstract A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.

Funder

European Society of Cardiology

Council on Stroke

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine

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