# Neurological Complications in Surgical Patients with Left-Sided Infective Endocarditis: Risk Factors, Prognosis, and Surgical Timing

## TL;DR

This study examines neurological complications in patients with left-sided infective endocarditis and finds that certain factors increase the risk of complications, though they don't necessarily worsen overall survival.

## Contribution

The study identifies specific risk factors and surgical timing effects on neurological outcomes in infective endocarditis patients.

## Key findings

- Mitral valve involvement and highly mobile vegetations are risk factors for neurological complications.
- Cerebral hemorrhage predicts in-hospital mortality and new-onset cerebral complications.
- Early surgery in infarction patients increases neurological complication rates.

## Abstract

Background: The aim of this study was to explore the baseline characteristics, risk factors, and prognosis of surgical patients with left-sided valvular infective endocarditis (IE) complicated by preoperative neurological complications, as well as the impact of complication subtypes and surgical timing on outcomes. Methods: A retrospective analysis of 605 consecutive surgical patients with left-sided valvular IE (May 2012–June 2024) was performed. Patients were stratified into neurological complication and non-complication groups, with 1:1 propensity score matching (PSM) balancing baseline confounders. Six neurological complication subtypes were defined; surgical timing was categorized as early (≤7 days for infarction, ≤30 days for hemorrhage) or delayed. Logistic/Cox regression analyzed risk factors and prognosis; subgroup analyses compared modified Rankin Scale (mRS) scores, and Kaplan–Meier curves evaluated long-term survival. Results: Mitral valve involvement, highly mobile vegetations, and longer IE symptom-to-surgery time were risk factors for neurological complications. After PSM balancing, the neurological complications group had similar in-hospital, long-term mortality to the control group, but a significantly higher new-onset cerebral complication rate. In total, 81.5% of complication patients achieving mRS ≤ 2 (good functional status) with infarction showed improved postoperative mRS scores. Cerebral hemorrhage was an independent predictor of in-hospital mortality, while cerebral hemorrhage and regional infarction were independent predictors of new-onset cerebral complication. Early surgery in infarction patients increased the neurological complication rate. Conclusion: Neurological complication incidence was 27.8%. Mitral valve involvement, high vegetation mobility, and preoperative emboli were risk factors. Except for preoperative cerebral hemorrhage and regional infarction, which increase the risk of in-hospital mortality, neurological complications overall do not affect short-term and long-term mortality rates, but increase the risk of postoperative neurological deterioration. Individualized surgical timing is recommended.