{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T09:38:20Z","timestamp":1775986700603,"version":"3.50.1"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,10,15]],"date-time":"2020-10-15T00:00:00Z","timestamp":1602720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p\/><jats:p>A treatment dilemma arises when surgery is indicated in patients with infective endocarditis (IE) complicated by stroke. Neurologists recommend surgery to be postponed for at least 1\u2009month. This study aims to investigate the neurological complication rate and neurological recovery potential in patients with IE-related stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A total of 440 consecutive patients with left-sided IE undergoing surgery were investigated. During follow-up, neurological recovery was assessed using the modified Rankin scale and the Barthel index. Mortality was assessed with regression models adjusting for\u00a0age.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The median follow-up time was 9.0\u2009years. Patients with previous strokes were more likely to suffer from mitral valve endocarditis (29.5% vs 47.4%, P\u2009&amp;lt;\u20090.001). Symptomatic stroke was found in 135 (30.7%) patients; of them, 42 patients presented with complicated stroke (additional meningitis, haemorrhagic stroke or intracranial abscess). Driven by symptomatic stroke, the age-adjusted hospital mortality risk was 1.4-fold [95% confidence interval (CI) 0.74\u20132.57; P\u2009=\u20090.31] higher and the long-term mortality risk was 1.4-fold higher (95% CI 1.003\u20132.001; P\u2009=\u20090.048). Hospital mortality was higher in patients with complicated stroke (21.4% vs 9.7%; P\u2009=\u20090.06) only; however, mortality rates were similar comparing uncomplicated stroke versus no stroke. Among patients with complicated ischaemic strokes, the observed risk for intraoperative cerebral haemorrhage was 2.3% only and the increased hospital mortality was not driven by cerebral complications. In the long-term follow-up, full neurological recovery was observed in 84 out of 118 survivors (71.2%), and partial recovery was observed in 32 (27.1%) patients. Neurological recovery was lower in patients with complete middle cerebral artery stroke compared to other localization (52.9% vs 77.6%; P\u2009=\u20090.003).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Contrary to current clinical practice and neurological recommendations, early surgery in IE is safe and neurological recovery is excellent among patients with IE-related stroke.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical registration number local IRB<\/jats:title><jats:p>UN4232 382\/3.1 (retrospective study).<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa239","type":"journal-article","created":{"date-parts":[[2020,6,12]],"date-time":"2020-06-12T19:12:31Z","timestamp":1591989151000},"page":"1161-1167","source":"Crossref","is-referenced-by-count":16,"title":["Endocarditis-related stroke is not a contraindication for early cardiac surgery: an investigation among 440 patients with left-sided endocarditis"],"prefix":"10.1093","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5836-0875","authenticated-orcid":false,"given":"Elfriede","family":"Ruttmann","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1470-6026","authenticated-orcid":false,"given":"Hannes","family":"Abfalterer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ludwig","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3118-4637","authenticated-orcid":false,"given":"Katie","family":"Bates","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5911-1002","authenticated-orcid":false,"given":"Hanno","family":"Ulmer","sequence":"additional","affiliation":[{"name":"Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaos","family":"Bonaros","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"key":"2020112808171409600_ezaa239-B1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1093\/ehjqcco\/qcw039","article-title":"Increased incidence of infective endocarditis after the 2009 European Society of Cardiology guideline update: a nationwide study in the Netherlands","volume":"3","author":"Van den Brink","year":"2017","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2020112808171409600_ezaa239-B2","doi-asserted-by":"crossref","first-page":"2070","DOI":"10.1016\/j.jacc.2015.03.518","article-title":"Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States 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