What is the timing of valve surgery in IE patients with stroke?
The timing of valve surgery in IE patients with stroke remains controversial. Stroke is an independent risk factor for post-operative mortality in IE patients. After stroke, neurological deterioration can occur as a result of hemorrhagic transformation with anticoagulation during cardiopulmonary bypass or exacerbation of cerebral ischemia attributable to hypotension during cardiac surgery. The risk of intracranial hemorrhage is dependent on several factors, including extent and size of infarction, whether it is ischemic or hemorrhagic, and the exact timing of surgery. One clinical quandary is whether early valve surgery can be safely performed within 7 days after a stroke or if it is better to postpone surgery for at least 1 week. No randomized trials have addressed this conundrum.