The Influence of Preoperative Neurological Complications on Outcomes after Surgery for Infective Endocarditis

Background. Infective endocarditis (IE) is considered a life-threatening cardiac infection with a predilection to involve heart valves. One of the most feared complications of IE is the development of new-onset neurological complications (NCs). The aim of this study is to compare the short- and long-term outcomes of surgery in patients with IE presenting with vs. without NCs. Methods. We retrospectively reviewed patient records which were regularly collected in our institutional database. Between January 2002 and August 2020, 438 consecutive patients who underwent open cardiac surgery in our university hospital due to IE were included in the retrospective study. Results. Of the total cohort, 89 patients (20.3%) had preoperative NCs. Patients in the NC group were more likely to be female (33.7% vs. 23.5%; $P=0.049$), had more acute kindly injury at presentation (22.5% vs. 10.0%; $P=0.002$), were more likely to be admitted to ICU (36.0% vs. 18.3%; $P<0.001$), and had significantly more vegetations (84.3% vs. 69.8%; $P=0.006$) and overall higher preoperative embolization (92.1% vs. 11.7%; $P<0.001$). Staphylococcus aureus as causative organism of IE was significantly higher in the NC group (35.2% vs. 16.1%; $P<0.001$). Patients in the NC group had significantly higher affection of the mitral valve. There was no difference in postoperative outcomes between the two groups. The long-term survival was also similar in both groups. Preoperative atrial fibrillation (adjusted odds ratio (aOR): 2.03; 95% CI [1.04–3.93]; $P=0.037$) and Staphylococcus aureus IE (aOR: 2.60; 95% CI [1.4–4.8]; $P=0.002$) were independent risk factors of developing NCs, while previous endocarditis was a protective factor (aOR: 0.33; 95% CI [0.11–0.99]; $P=0.048$). Conclusion. Our study emphasizes the shared risk factors between mortality and developing NCs. NCs are critical in IE’s clinical presentation, but they do not independently predict short- or long-term survival following surgery for IE.