Cerebral complications are frequent in infective endocarditis (IE) and are associated with adverse prognosis, raising uncertainty regarding optimal surgical timing. A prospective cohort study conducted in Aquitaine, France (2013–2021) evaluated characteristics and outcomes of IE patients with cerebral complications managed surgically or medically. The study was published in the Canadian Journal of Cardiology.

Consecutive patients with IE-related cerebral events were included and classified based on whether cardiac surgery was performed. The primary outcome was all-cause mortality at 1 month, while secondary outcomes included mortality up to 1 year and the influence of cerebral lesion type and surgical timing.

Among 1,230 patients with IE, 288 (mean age 65±14 years; 74% male) presented with cerebral complications. Ischemic lesions were observed in 76% of patients, while 19% had hemorrhagic lesions. Severe valvular damage was reported in 43% of cases, and cardiac surgery was indicated in 86%. 

At 1 month, mortality was significantly higher in non-operated patients compared with those undergoing surgery (27% vs 5.9%; P<0.001). Multivariate analysis identified heart failure (HF), coma, and cardiac surgery (odds ratio [OR] 0.24; 95% confidence interval [CI] 0.10–0.56; P<0.001) as independent predictors of mortality. Cerebral lesion type and timing of surgery were not associated with differences in prognosis.

Cardiac surgery was associated with lower short-term mortality in IE with cerebral complications. A multidisciplinary Endocarditis Team approach with neurology expertise is recommended when surgery is indicated.