Outcomes of early surgery for infective endocarditis with moderate cerebral complications Ryosuke Murai, MD, Shunsuke Funakoshi, MD, Shuichiro Kaji,

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Outcomes of early surgery for infective endocarditis with moderate cerebral complications Ryosuke Murai, MD, Shunsuke Funakoshi, MD, Shuichiro Kaji, MD, PhD, Takeshi Kitai, MD, PhD, Kitae Kim, MD, Tadaaki Koyama, MD, PhD, Yutaka Furukawa, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 4, Pages 831-840.e8 (April 2017) DOI: 10.1016/j.jtcvs.2016.10.074 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Diagram showing initial treatment modalities for all patients. IE, Infective endocarditis; NIHSS, National Institutes of Health Stroke Scale. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 831-840.e8DOI: (10.1016/j.jtcvs.2016.10.074) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Comparison of IE-related mortality and MACE between patients with severe stroke and those with nonsevere stroke. A, Survival curves free from IE-related death. B, Survival curves free from MACE. IE, Infective endocarditis; MACE, major adverse cardiac events. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 831-840.e8DOI: (10.1016/j.jtcvs.2016.10.074) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Comparison of IE-related mortality and MACE between early surgery and conventional treatment in patients with severe stroke. A, Survival curves free from IE-related death. B, Survival curves free from MACE. IE, Infective endocarditis; Conv., conventional treatment; MACE, major adverse cardiac events. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 831-840.e8DOI: (10.1016/j.jtcvs.2016.10.074) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Comparison of IE-related mortality and MACE between early surgery and conventional treatment in patients with nonsevere stroke. A, Survival curves free from IE-related death. B, Survival curves free from MACE. C, IPTW-weighted survival curves free from IE-related death. D, IPTW-weighted survival curves free from MACE. IE, Infective endocarditis; MACE, major adverse cardiac events; Conv., conventional treatment. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 831-840.e8DOI: (10.1016/j.jtcvs.2016.10.074) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Propensity scores for early operation in the early operation and conventional treatment population. Conv., Conventional treatment. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 831-840.e8DOI: (10.1016/j.jtcvs.2016.10.074) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Survival curves free from infective endocarditis−related death in patients with nonsevere stroke. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 831-840.e8DOI: (10.1016/j.jtcvs.2016.10.074) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 A 77-year-old man was admitted to our hospital with 2-week history of persistent fever and transient paralysis of right arm. Serial sets of blood culture were positive for Streptococcus mitis. Magnetic resonance imaging of the brain revealed multiple acute cerebral infarcts. Transthoracic echocardiography revealed large vegetation on the mitral valve. He was diagnosed as having infective endocarditis and underwent mitral valve repair and coronary artery bypass grafting 10 days after the diagnosis. His postoperative course was uneventful, and he was discharged without any neurologic deficit. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31481-7/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 831-840.e8DOI: (10.1016/j.jtcvs.2016.10.074) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions