Inter-Operative Time between Neurosurgery and Cardiac Surgery for Native Valve Endocarditis

Document Type : Case Report


Department of Surgery, University of Arizona Medical Center, University of Arizona, Tucson, AZ, United States.


Introduction: Infective endocarditis is well known to produce neurologic complications from septic emboli, which mandates a multidisciplinary approach between neurosurgery and cardiac surgery. However, literature is not clear as to the optimal interval length between neurosurgery and cardiac surgery.

Presentation of Cases: The first case involves a 60-year-old woman with significant past medical history presenting with native valve methicillin-resistant staphylococcus aureus (MRSA) endocarditis causing cerebral vascular infarcts. The second case involves a 45-year-old man with no significant past medical history presenting with infective endocarditis of the aortic and mitral valve.

Discussion: Cardiac surgery was performed 27 and 17 days after neurosurgery intervention for each case, respectively. All operations were successful with few complications. Guidelines suggest waiting at least one week until valvular surgery, but other reports suggest earlier surgery produces preferable outcomes. In the cases presented, both patients experienced no further significant events to date after receiving cardiac surgery >3 weeks after the initial ischemic stroke event.

Conclusion: Neurological deficits mandate a collaborative approach between neurosurgery and cardiac surgery. Significance between time of neurosurgical intervention and cardiac surgery remains controversial, but waiting at least one week shows positive results.


1.Wilbring M, Irmscher L, Alexiou K, Matschke K, Tugtekin SM. The impact of preoperative neurological events in patients suffering from native infective valve endocarditis. Interact Cardiovasc Thorac Surg. 2014; 18:740-7.
2.Misfeld M, Girrbach F, Etz CD, Binner C, Aspern KV, Dohmen PM, et al. Surgery for infective endocarditis complicated by cerebral embolism: a consecutive series of 375 patients. J Thorac Cardiovasc Surg. 2014; 147:1837-44.
3.Miura T, Eishi K. Current treatment of active infective endocarditis with brain complications. Gen Thorac Cardiovasc Surg. 2013; 61:551-9.
4.Chun JY, Smith W, Halbach VV, Higashida RT, Wilson C, Lawton MT. Current multimodality management of infectious intracranial aneurysms. Neurosurgery. 2001; 48:1203-13.
5.Parrino PE, Kron IL, Ross SD, Shockey KS, Kron AM, Towler MA, et al. Does a focal neurologic deficit contraindicate operation in a patient with endocarditic? Ann Thorac Surg. 1999; 67:59-64.
6.Piper C, Wiemer M, Schulte HD, Horstkotte D. Stroke is not a contraindication for urgent valve replacement in acute infective endocarditis. J Heart Valve Dis. 2001; 10:703-11.
7.Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J. 2009; 30:2369–413.
8.Chapot R, Houdart E, Saint-Maurice JP, Aymard A, Mounayer C, Lot G, et al. Endovascular treatment of cerebral mycotic aneurysms. Radiology. 2002; 222:389-96.
9.Ruttmann E, Willeit J, Ulmer H, Chevtchik O, Hofer D, Poewe W, et al. Neurological outcome of septic cardioembolic stroke after infective endocarditis. Stroke. 2006; 37:2094-9.
10. Gillinov AM, Shah RV, Curtis WE, Stuart RS, Cameron DE, Baumgartner WA, et al. Valve replacement in patients with endocarditis and acute neurologic deficit. Ann Thorac Surg. 1996; 61:1125-9.
11. Eishi K, Kawazoe K, Kuriyama Y, Kitoh Y, Kawashima Y, Omae T. Surgical management of infective endocarditis associated with cerebral complications: multi-center retrospective study in Japan. J Thorac Cardiovasc Surg. 1995; 110:1745-55.
12. Yoshioka D, Toda K, Sakaguchi T, Okazaki S, Yamauchi T, Miyagawa S, et al. Valve surgery in active endocarditis patients complicated by intracranial haemorrhage: the influence of timing of surgery on neurologic outcomes. Eur J Cardio Thorac Surg. 2014; 45:1082-88.