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

Nikolaos Bonaros, Martin Czerny, Bettina Pfausler, Silvana Müller, Thomas Bartel, Matthias Thielmann, Sharaf-Eldin Shehada, Thierry Folliguet, Jean-Francois Obadia, Johannes Holfeld, Roberto Lorusso, Alessandro Parolari, Ludwig Müller, Michael Grimm, Elfriede Ruttmann-Ulmer
European Heart Journal Supplements: Journal of the European Society of Cardiology 2020, 22 (Suppl M): M19-M25
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.

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