10_OA_13.02265 Fukuda.indd

Although recent advances in surgical techniques have improved prognosis, infective endocarditis (IE) remains associated with high in-hospital and long-term mortality rates, ranging from 15% to 25%.1,2) The nervous system is frequently involved in IE patients, and neurological symptoms have been observed in 20% to 40% of patients with IE.3–5) A treatment dilemma arises when IE is complicated by cerebrovascular events. The appropriate timing of surgery for active IE in patients with recent cerebrovascular event is controversial because the systemic heparinization and cardiopulmonary bypass (CPB) needed to treat the IE may exacerbate neurological damage.6) Cerebral infarctions may transform into hemorrhagic infarction, and hemorrhagic strokes may be extended. Hypoperfusion either during CPB or postoperative Management of Infective Endocarditis with Cerebral Complications