Stroke is not a Contraindication for Urgent Valve Replacement in Acute Infective Endocarditis
Cornelia Piper MD, Marcus Wiemer MD, Hagen D. Schulte MD, Dieter Horstkotte MD

A therapeutic dilemma arises when endocarditis is complicated by cerebral embolism. On the one hand, urgent surgery is indicated to prevent further thromboembolic events in case of a remaining large valvular vegetation; on the other hand, secondary cerebral hemorrhagic complications may arise following suppression of plasmatic coagulation in association with extracorporeal circulation. A total of 288 consecutive patients with proven endocarditis was investigated with regard to frequency of thromboembolic events (particularly cerebral), prognostic influence of each treatment strategy chosen after the onset of complications and secondary hemorrhagic risk following urgent surgery. The prognosis for patients who had surgery within 72 h after stroke was significantly more favorable (p <0.0001) than for those not treated surgically or operated on >8 days after the event. The risk of a secondary cerebral hemorrhage during this period (<72 h) appears to be low, if early reperfusion hemorrhage is excluded by perioperative cranial computed tomography.