The impact of preoperative neurologic events in patients suffering from native infective valve endocarditis

Aims: Patients suffering from native valve endocarditis (NVE) complicated by new onset cerebral events still remain a surgical challenge. We report our results over the past decade regarding this high-risk patients with particular concern on the timing of operation.

Patients and methods: Between 1997 and 2007 474 patients were admitted to our hospital due to NVE. Out of these, 60 patients (12.7%) showed neurologic complications. Mean age was 55 ± 15 years, 80.0% were male. Most cases were emergency procedures (78.3%). Mean follow up time was 3.2 ± 1.9 years.

Results: Neurologic complications consisting of TIA, PRIND or permanent stroke occurred in 60 patients (n = 60/474, 12.7%). Most patients suffered from stroke due to cerebral embolic events (n = 50/60, 83.3%). Seven patients (n = 7/60, 11.7%) had a hemorrhagic stroke and further three (n = 3/60, 5.0%) suffered cerebral abscesses. Mean time interval between stroke and cardiac surgery was 8.7 ± 10.3 days. Hospital mortality was – mostly in consequence of septic multiorgan failure – significant elevated with 19.5% in comparison to patients without neurologic events (10.9% respectively; p = 0.0423),. During whole follow-up mortality raised up to 26.8% (n = 16/60). Nine patients (n = 9/60, 15.0%) demonstrated postoperative new onset neurologic events. Most of these (n = 4/9, 44.4%) were transient neuropsychiatric alterations, 22% (n = 2/9) were embolic events. We observed no impairment of preoperative neurologic status during the follow up.

Conclusions: NVE complicated by neurologic events remains a challenging disease with high mortality and morbidity. Cardiosurgical intervention is still associated with impaired outcome but seems not to aggravate preoperative existing neurologic symptoms.