Surgical Management of Infective Endocarditis Complicated With Acute Cerebral Infarction ― Preoperative Management Using Modified Rankin Scale and Sequential Organ Failure Assessment (SOFA) Score

Background: The optimal timing of surgery for infective endocarditis (IE) with acute cerebral infarction (CI) remains controversial. We examined the surgery policy at Ise Red Cross Hospital after negative blood cultures and antibiotic administration for at least 2 weeks. Methods and Results: Thirty-nine IE patients who underwent surgery between 2012 and 2020 were divided into Groups S (n=13; with acute CI) and N (n=26; without acute CI). Patients with IE who underwent conservative treatment were classified as group C (n=16). At the time of IE diagnosis, the modified Rankin Scale (mRS) score was significantly higher in Group S than Group N (mean [+/- SD] 3.9 +/- 0.6 vs. 2.8 +/- 1.3; P=0.009). However, there was no significant difference between Groups S and N moments before surgery (3.0 +/- 1.5 vs. 2.1 +/- 1.5, respectively; P=0.10) or at discharge (2.7 +/- 0.8 vs. 2.6 +/- 0.9, respectively; P=0.89). There were no significant differences in the Sequential Organ Failure Assessment (SOFA) score between groups. There were no differences in intra- and postoperative outcomes between Groups S and N. In Group C, the mRS score was significantly higher at discharge than in Group S (2.7 +/- 0.8 vs. 4.4 +/- 0.8, respectively; P<0.001), and long-term results were poor (P=0.004). Conclusions: Preoperative management and the timing of surgery for IE patients using the mRS and SOFA scores at our institution were reasonable.