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

Introduction: Infective endocarditis is well known to produce neurologic complications from septic emboli, which mandates a multidisciplinary approach including neurosurgery and cardiac surgery. However, the literature is not conclusive as to the optimal interval between neurosurgery and cardiac surgery. Case Report: The first case is 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 is a 45-year-old man with no significant past medical history presenting with infective endocarditis of the aortic and mitral valve. Discussion: After neurosurgical intervention cardiac surgery was performed 27 and 17 days later 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. Conclusion: Neurological deficits mandate a collaborative approach between neurosurgery and cardiac surgery. The significance of the time between neurosurgical intervention and cardiac surgery remains controversial, but waiting at least one week shows positive results.