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

Bruno Barsic, Stuart A. 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, Liliana ClaraMarisa Sanchez, Francisco Nacinovich, Pablo Fernandez Oses, Ricardo Ronderos, Adriana Sucari, Jorge Thierer, José Casabé, Claudia Cortes, Silvia Kogan, Denis Spelman, Eugene Athan, Owen Harris, Karina Kennedy, Ren Tan, David Gordon, Lito Papanicolas, Damon Eisen, Leeanne Grigg, Alan Street, Tony Korman, Despina Kotsanas, Robyn Dever, Phillip Jones, Pam Konecny, Richard Lawrence, David Rees, Suzanne Ryan, Michael P. Feneley, John Harkness, Jeffrey Post, Porl Reinbott, Rainer Gattringer, Franz Wiesbauer, Adriana Ribas Andrade, Ana Cláudia Passos De Brito, Armenio Costa Guimarães, Max Grinberg, Alfredo José Mansur, Rinaldo Focaccia Siciliano, Tania Mara Varejao Strabelli, Marcelo Luiz Campos Vieira, Regina Aparecida De Medeiros Tranchesi, Marcelo Goulart Paiva, Auristela De Oliveira Ramos, Giovanna Ferraiuoli, Wilma Golebiovski, Cristiane Lamas, Marisa Santos, Clara Weksler, James A. Karlowsky, Yoav Keynan, Andrew M. Morris, Ethan Rubinstein, Sandra Braun Jones, Patricia Garcia, M. Cereceda, Alberto Fica, Rodrigo Montagna Mella, Suzana Bukovski, Tomas Freiberger, Jiri Pol, Barbora Zaloudikova, Zainab Ashour, Amani El Kholy, Marwa Mishaal, Hussien Rizk, Neijla Aissa, Corentine Alauzet, Francois Alla, Catherine Campagnac, Thanh Doco-Lecompte, Christine Selton-Suty, Jean Paul Casalta, Pierre Edouard Fournier, Gilbert Habib, Didier Raoult, Franck Thuny, Armelle Delahaye, Francois Vandenesch, Erwan Donal, Pierre Yves Donnio, Christian Michelet, Matthieu Revest, Pierre Tattevin, Jérémie Violette, Florent Chevalier, Antoine Jeu, Dan Rusinaru, Claire Sorel, Christophe Tribouilloy, Yvette Bernard, Catherine Chirouze, Bruno Hoen, Joel Leroy, Patrick Plesiat, Germa Christoph Naber, Carl Neuerburg, Bahram Mazaheri, Christoph Naber, Sofia Athanasia, Efthymia Giannitsioti, Elena Mylona, Olga Paniara, Konstantinos Papanicolaou, John Pyros, Athanasios Skoutelis, Gautam Sharma, Johnson Francis, Lathi Nair, D. M.Vinod Thomas, Krishnan Venugopal, Margaret Hannan, John Hurley, Amos Cahan, Dan Gilon, Sarah Israel, Maya Korem, Jacob Strahilevitz, Marie Françoise Tripodi, Roberta Casillo, Susanna Cuccurullo, Giovanni Dialetto, Emanuele Durante-Mangoni, Mattucci Irene, Enrico Ragone, Riccardo Utili, Enrico Cecchi, Francesco De Rosa, Davide Forno, Massimo Imazio, Rita Trinchero, Alessandro Tebini, Paolo Grossi, Mariangela Lattanzio, Antonio Toniolo, Antonio Goglio, Annibale Raglio, Veronica Ravasio, Marco Rizzi, Fredy Suter, Silvia Magri, Liana Signorini, Tania Baban, Zeina Kanafani, Souha S. Kanj, Jad Sfeir, Mohamad Yasmine, Imran Abidin, Eduardo Rivera Martínez, Gabriel Israel Soto Nieto, Jan T.M. Van Der Meer, Stephen Chambers, David R. Murdoch, David Holland, Arthur Morris, Nigel Raymond, Kerry Read, Stefan Dragulescu, Adina Ionac, Cristian Mornos, O. M. Butkevich, Natalia Chipigina, Ozerecky Kirill, Kulichenko Vadim, Tatiana Vinogradova, Magid Halim, Luh Nah Lum, Ru San Tan, Tatjana Lejko-Zupanc, Mateja Logar, Manica Mueller-Premru, Patrick Commerford, Anita Commerford, Eduan Deetlefs, Cass Hansa, Mpiko Ntsekhe, Manuel Almela, Yolanda Armero, Manuel Azqueta, Ximena Castañeda, Carlos Cervera, Ana Del Rio, Carlos Falces, Cristina Garcia-De-La-Maria, Guillermina Fita, Jose M. Gatell, Francesc Marco, Carlos A. Mestres, José M. Miró, Asuncion Moreno, Salvador Ninot, Carlos Paré, Joan Pericas, Jose Ramirez, Irene Rovira, Marta Sitges, Ignasi Anguera, Bernat Font, Joan Raimon Guma, Javier Bermejo, Emilio Bouza, Miguel Angel Garcia Fernández, Victor Gonzalez-Ramallo, Mercedes Marín, Patricia Muñoz, Miguel Pedromingo, Jorge Roda, Marta Rodríguez-Créixems, Jorge Solis, Benito Almirante, Nuria Fernandez-Hidalgo, Pilar Tornos, Arístides De Alarcón, Ricardo Parra, Eric Alestig, Magnus Johansson, Ulrika Snygg-Martin, Orathai Pachirat, Pimchitra Pachirat, Burabha Pussadhamma, Vichai Senthong, Anna Casey, Tom Elliott, Peter Lambert, Richard Watkin, Christina Eyton, John L. Klein, Suzanne Bradley, Carol Kauffman, Roger Bedimo, International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators

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Abstract

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
Volume56
Issue number2
DOIs
Publication statusPublished - 15 Jan 2013

Keywords

  • endocarditis
  • stroke
  • surgery

Cite this

Barsic, B., Dickerman, S. A., Krajinovic, V., Pappas, P., Altclas, J., Carosi, G., Casabé, J. H., Chu, V. H., Delahaye, F., Edathodu, J., Fortes, C. Q., Olaison, L., Pangercic, A., Patel, M., Rudez, I., Tamin, S. S., Vincelj, J., Bayer, A. S., Wang, A., ... International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators (2013). Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke. Clinical Infectious Diseases, 56(2), 209-217. https://doi.org/10.1093/cid/cis878