284THE IMPACT OF PREOPERATIVE NEUROLOGICAL EVENTS IN PATIENTS SUFFERING FROM NATIVE INFECTIVE VALVE ENDOCARDITIS

Objectives: Patients suffering from native valve endocarditis (NVE) complicated by new onset cerebral events still remain a surgical challenge. We report our results over the past decade regarding this high-risk patient group with particular concern for the timing of operation. Methods: Between 1997 and 2007, 474 patients were admitted to our hospital due to NVE. Out of these, 60 patients (12.7%) showed neurological complications. The mean age was 55 ± 15 years; 80% were male. Most cases were emergency procedures (78.3%). Mean follow-up time was 3.2 ± 1.9 years. Results: Neurological complications consisting of transient ischaemic attack, prolonged reversible ischaemic neurological deficit, or permanent stroke occurred in 60 patients (n = 60/474, 12.7%). Most patients suffered from stroke due to cerebral embolic events (n = 50/60, 83.3%). Seven patients (n = 7/60, 11.7%) had a haemorrhagic stroke and a further three (n = 3/60, 5.0%) suffered cerebral abscesses. The mean time interval between stroke and cardiac surgery was 8.7 ± 10.3 days. Hospital mortality (mostly in consequence of septic multiorgan failure) was significantly elevated at 19.5% in comparison to patients without neurological events (10.9%), P = 0.0423). During follow-up, mortality increased to 26.8% (n = 16/60). Nine patients (n = 9/60, 15.0%) demonstrated postoperative new onset neurological events. Most of these (n = 4/9, 44.4%) were transient neuropsychiatric alterations; 22% (n = 2/9) were embolic events. We observed no impairment of preoperative neurological status during the entire follow-up. Conclusions: NVE complicated by neurological events remains a challenging disease with high mortality and morbidity. Cardiac surgical intervention is still associated with impaired outcome but seems not to aggravate preoperative existing neurological symptoms in the observed time interval.