The enigma of timing for cardiac surgery in aortic valve infective endocarditis with cerebrovascular complications: a case report
Abstract
Despite considerable improvements in therapeutic opportunities, infective endocarditis (IE) still suffers from a high morbidity and mortality rate, with septic embolism from valvular vegetations being one of its most dreadful complications. In complicated cases, early cardiac surgery can represent the greatest opportunity to improve the patient’s prognosis, yet it encounters many issues that limit its indication. Herein, we present a case of an 80-year-old woman with native valve IE causing embolic ischemic stroke, delaying early cardiac surgery, and requiring complex multidisciplinary management. The case summarizes the pros and cons of the delayed surgery approach, which may allow a longer duration of antibiotic therapy and reduced risks of neurologic worsening but may enhance the risk of valve destruction, heart block, embolic complications, and death. This case reveals many critical aspects indicating early intervention despite very high surgical risk, providing insights into knowledge gaps and clinical needs for future research on this topic.
References
- Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023;44:3948-4042. DOI: https://doi.org/10.1093/eurheartj/ehad193
- Bonaros N, Czerny M, Pfausler B, et al. Infective endocarditis and neurologic events: indications and timing for surgical interventions. Eur Heart J Suppl 2020;22:M19-25. DOI: https://doi.org/10.1093/eurheartj/suaa167
- Wang A, Fosbøl EL. Current recommendations and uncertainties for surgical treatment of infective endocarditis: a comparison of American and European cardiovascular guidelines. Eur Heart J 2022;43:1617-25. DOI: https://doi.org/10.1093/eurheartj/ehab898
- Arregle F, Martel H, Philip M, et al. Infective endocarditis with neurological complications: Delaying cardiac surgery is associated with worse outcome. Arch Cardiovasc Dis 2021;114:527-36. DOI: https://doi.org/10.1016/j.acvd.2021.01.004
- Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. J Am Coll Cardiol 2021;77:450-500. DOI: https://doi.org/10.1016/j.jacc.2020.11.035
- Tam DY, Yanagawa B, Verma S, et al. Early vs late surgery for patients with endocarditis and neurological injury: a systematic review and meta-analysis. Can J Cardiol 2018;34:1185-99. DOI: https://doi.org/10.1016/j.cjca.2018.05.010
- Carneiro TS, Awtry E, Dobrilovic N, et al. Neurological complications of endocarditis: a multidisciplinary review with focus on surgical decision making. Semin Neurol 2019;39:495-506. DOI: https://doi.org/10.1055/s-0039-1688826
- Yanagawa B, Pettersson GB, Habib G, et al. Surgical management of infective endocarditis complicated by embolic stroke: practical recommendations for clinicians. Circulation 2016;134:1280-92. DOI: https://doi.org/10.1161/CIRCULATIONAHA.116.024156
- Pazdernik M, Iung B, Mutlu B, et al. Surgery and outcome of infective endocarditis in octogenarians: prospective data from the ESC EORP EURO-ENDO registry. Infection 2022;50:1191-202. DOI: https://doi.org/10.1007/s15010-022-01792-0
- Brancheau D, Degheim G, Machado C. Timing for pacing after acquired conduction disease in the setting of endocarditis. Case Rep Cardiol 2015;2015:471046. DOI: https://doi.org/10.1155/2015/471046
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