{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:18:02Z","timestamp":1787314682411,"version":"build-2736575974"},"reference-count":19,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T00:00:00Z","timestamp":1621036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cerebral embolism due to infective endocarditis (IE) is associated with significant morbidity and mortality. The optimal time-interval between symptomatic stroke and cardiac surgery remains unclear. This study aimed to analyze the patients\u2019 outcomes and define the potential risk factors with regard to surgical timing for IE patients with preoperative symptomatic cerebral embolism (CE). A total of 119 IE patients with CE were identified and analyzed with regard to operative timing: early (1\u20137 days), intermediate (8\u201321 days), and late (&gt;22 days). The preoperative patient data, comorbidities and previous cardiac surgical procedures were analyzed to identify potential predictors and independent risk factors for in-hospital mortality using univariate and multivariate regression analysis. Actuarial survival was estimated by the Kaplan-Meier method. In-hospital mortality for the entire study cohort was 15.1% (n = 18), and in comparison, between groups was found to be highest in the intermediate surgical group (25.7%). Univariate analysis identified preoperative mechanical ventilation dependent respiratory insufficiency (p = 0.006), preoperative renal insufficiency (p = 0.019), age (p = 0.002), large vegetations (p = 0.018) as well as intermediate (p = 0.026), and late (p = 0.041) surgery as predictors of in-hospital mortality. The presence of large vegetations (&gt;8 mm) (p = 0.019) and increased age (p = 0.037)\u2014but not operative timing\u2014were identified as independent risk factors for in-hospital mortality. In the presence of large vegetations (&gt;8 mm), cardiac surgery should be performed early and independently from the entity of cerebral embolic stroke. Postponing surgery to achieve clinical stabilization and better postoperative outcomes of IE patients with CE is reasonable, however, worsening of the disease process with deterioration and resulting heart failure during the first 3 weeks after CE results in a significantly higher in-hospital mortality and inferior long-term survival.<\/jats:p>","DOI":"10.3390\/jcm10102136","type":"journal-article","created":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T23:17:16Z","timestamp":1621207036000},"page":"2136","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of Operative Timing in Infective Endocarditis with Cerebral Embolism\u2014The Risk of Intermediate Deterioration"],"prefix":"10.3390","volume":"10","author":[{"given":"Alexey","family":"Dashkevich","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Bratkov","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2063-1067","authenticated-orcid":false,"given":"Yupeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Political Science and Economics, Rowan University, Glassboro, NJ 08028, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3995-8737","authenticated-orcid":false,"given":"Dominik","family":"Joskowiak","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-152X","authenticated-orcid":false,"given":"Sven","family":"Peterss","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerd","family":"Juchem","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hagl","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Luehr","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital, LMU Munich, 81377 Munich, Germany"},{"name":"Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3222","DOI":"10.1093\/eurheartj\/ehz620","article-title":"Clinical presentation, aetiology and outcome of infective endocarditis. 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Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/10\/2136\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:01:50Z","timestamp":1760162510000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/10\/2136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,15]]},"references-count":19,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,5]]}},"alternative-id":["jcm10102136"],"URL":"https:\/\/doi.org\/10.3390\/jcm10102136","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,15]]}}}