Introduction: To determine whether preoperative symptomatic neurological complication (SNC) predicts a worse prognosis of patients with active left-sided infective endocarditis who required early surgery.

Methods: We conducted a retrospective chart review and analyzed risk factors for SNCs and immediate, medium-term, and long-term mortality in patients with active left-sided infective endocarditis who required early surgery (median follow-up: 70.5 months).

Results: Of 212 included patients, preoperative SNCs occurred in 22.1%. Independent risk factors for preoperative SNC included early hospital admission (<10 days after symptoms onset), duration of antibiotic therapy <7 days, vegetation diameter > 30 mm, preoperative chronic therapy with steroids, and peripheral embolism. A new postoperative SNC occurred in 12.7% of patients. No significant differences related to preoperative or postoperative SNCs were observed in postoperative mortality (29.8% vs. 31.5%) or during follow-up. No significant differences in postoperative mortality were observed between hemorrhagic or ischemic SNCs. There was a non-significant trend to increased mortality in patients who underwent surgery within 7 days of presenting with SNC (55.5%) compared to those who underwent surgery more than 7 days after SNC (33.3%) (P = 0.171). Concomitant risk of mortality or postoperative hemorrhagic transformation increased when surgery is required during the first week after preoperative SNC (77.5% vs. 25%) (P = 0.017).

Conclusions: Patients with active left-sided infective endocarditis who need early hospital admission are at a higher risk of SNC. Mortality is higher in patients who underwent surgery within 7 days of SNC, but mortality of early surgery is acceptable after the first week of preoperative ischemic or hemorrhagic complication. We have not been able to demonstrate that preoperative nor postoperative SNCs predicted a reduced immediate, medium-term, or long-term survival in the population analyzed in this study.

介绍： 确定术前症状性神经系统并发症 (SNC) 是否预示需要早期手术的活动性左侧感染性心内膜炎患者的预后较差。

方法： 我们对需要早期手术的活动性左侧感染性心内膜炎患者进行了回顾性图表审查，并分析了 SNC 的危险因素以及即刻、中期和长期死亡率（中位随访时间：70.5 个月）。

结果：在纳入的 212 名患者中，22.1% 的患者发生了术前 SNC。术前 SNC 的独立危险因素包括早期入院（症状出现后 <10 天）、抗生素治疗持续时间 <7 天、赘生物直径 > 30 毫米、术前使用类固醇长期治疗和外周栓塞。12.7% 的患者发生了新的术后 SNC。在术后死亡率（29.8% 对 31.5%）或随访期间，没有观察到与术前或术后 SNC 相关的显着差异。在出血性或缺血性 SNC 之间没有观察到术后死亡率的显着差异。与在 SNC 后 7 天内接受手术的患者 (33.3%) 相比，在出现 SNC 后 7 天内接受手术的患者 (55.5%) 的死亡率没有显着增加趋势。磷= 0.171）。术前 SNC 后第一周需要手术时，伴随死亡或术后出血转化的风险增加（77.5% 对 25%）（磷 = 0.017）。

结论：需要早期住院的活动性左侧感染性心内膜炎患者发生 SNC 的风险较高。在 SNC 后 7 天内接受手术的患者死亡率较高，但在术前缺血性或出血性并发症第一周后早期手术的死亡率是可以接受的。我们未能证明术前或术后 SNC 可预测本研究中分析的人群的即时、中期或长期生存率降低。