Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke

Bruno Barsic, Stuart Dickerman, Vladimir Krajinovic, Paul Pappas, Javier Altclas, Giampiero Carosi, José H. Casabé, Vivian H. Chu, Francois Delahaye, Jameela Edathodu, Claudio Querido Fortes, Lars Olaison, Ana Pangercic, Mukesh Patel, Igor Rudez, Syahidah Syed Tamin, Josip Vincelj, Arnold S. Bayer, Andrew Wang, International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) InvestigatorsDavid Gordon, Lito Papanicolas

Research output: Contribution to journalArticlepeer-review

108 Citations (Scopus)


Background. The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. Methods. Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates. Results. Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308; 95% confidence interval[CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328; adjusted hazard ratio, 1.138; 95% CI, .802-1.650). Conclusions. There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.

Original languageEnglish
Pages (from-to)209-217
Number of pages9
JournalClinical Infectious Diseases
Issue number2
Publication statusPublished - 15 Jan 2013
Externally publishedYes


  • endocarditis
  • stroke
  • surgery


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