Neurological risk in urgent valve replacement cardiac surgery for infective endocarditis with cerebrovascular complications - a case series

Background/Introduction The indications for urgent valve replacement in patients with infective endocarditis (IE) include uncontrolled infection, recurrent emboli, valve dysfunction and cardiac failure. The optimal timing of this surgery when IE is complicated by cerebrovascular events (such as cerebral infarction or haemorrhage) is controversial, largely due to the escalated risk of perioperative intracranial bleeding, given that the patient is fully anticoagulated and on cardiopulmonary bypass for the procedure. While current guidelines suggest waiting at least 2 weeks between the diagnosis of stroke and surgery, with a deteriorating clinical condition valve surgery might be beneficial if done earlier.