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demographics and risk profile heterogeneous, and the surgery often complex. In a retrospective multi-centre study by Eishi of 2523 patients with IE, 112 patients were identified with cerebral infarction and 34 with haemorrhagic stroke [3]. The operative mortality for those with an embolic stroke was 21.4%, and in those with a haemorrhagic stroke 17.6%. In this study, a significant correlation was demonstrated between the interval from neurological complication to surgery. Patients undergoing urgent surgery within 24 h had 66% mortality. In those undergoing surgery from 48 h until 7 days, mortality fell to 31%, and after this mortality continued to fall until, by 4 weeks, it was 7%. When examining the delay interval on neurological outcome in patients with embolic stroke, cerebral damage was exacerbated in 44% of patients undergoing surgery within 1 week gradually falling with time such that by 28 days it was 2.3%. The number of patients with haemorrhagic stroke was small and in this group there was no difference in neurological outcome in those who underwent early compared with those who underwent late surgery, suggesting that there is some risk of progression of cerebral damage irrespective of when surgery is undertaken. This study concluded that the risk of cerebral complications decreased to 10% in patients who underwent surgery after 2 weeks and to 2.3% in those who underwent surgery after 4 weeks. Similar results were demonstrated in a recent single-centre review [5]. This identified only 13 patients over a 10-year period who had suffered a pre-operative neurological event, 10 embolic and 3 haemorrhagic. In the subgroup suffering embolic stroke, eight underwent surgery within 2 weeks of stroke due to complications of IE. Following surgery, two patients suffered additional neurological events and five experienced at least a partial improvement in their pre-operative neurological state. Only one patient with a haemorrhagic stroke underwent early surgery due

european journal of cardio-thoracic surgery

Timing for surgery in patients with infective endocarditis and cerebrovascular complications--waiting may be best but results of early surgery are acceptable and improvements in neurology are common