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

Abstract

<strong>Introduction:</strong> 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.<br /><br /><strong>Presentation of Cases:</strong> 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.<br /><br /><strong>Discussion</strong>: 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. <br /><br /><strong>Conclusion:</strong> 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.