Can J Cardiol. 2026 Mar 19:S0828-282X(26)00271-0. doi: 10.1016/j.cjca.2026.03.022. Online ahead of print.
ABSTRACT
BACKGROUND: Cerebral complications in patients with infective endocarditis (IE) are common and worsen prognosis. Determining the optimal timing for cardiac surgery in this context remains challenging. This study aimed to describe the characteristics and outcomes of IE patients with cerebral complications, managed either surgically or medically.
METHODS: We analyzed all consecutive patients with IE-related cerebral complications enrolled in a prospective cohort in Aquitaine, France (2013-2021). Patients were classified as operated or non-operated. The primary outcome was all-cause mortality at 1 month; secondary outcomes included all-cause mortality up to 1 year and the impact of cerebral lesion type and surgical timing.
RESULTS: Among 1,230 IE patients, 288 had cerebral complications (age 65±14 years, 74% male). Ischemic and hemorrhagic cerebral lesions occurred in 76% and 19%, respectively. Severe valvular damages were present in 43% and cardiac surgery was indicated in 86% of cases. One month mortality was significantly higher among non-operated versus operated patients (27% vs. 5.9%, p<0.001). Multivariate analysis identified heart failure, coma and cardiac surgery (OR 0.24; 95% CI [0.10-0.56]; p<0.001) as independent predictors of mortality. Neither the type of cerebral lesion nor surgical timing appeared to affect prognosis.
CONCLUSIONS: When indicated, cardiac surgery should be systematically discussed in IE patients with cerebral complications. Early intervention guided by a multidisciplinary Endocarditis Team including neurology expertise may improve outcomes.
PMID:41864422 | DOI:10.1016/j.cjca.2026.03.022