The enigma of timing for cardiac surgery in aortic valve infective endocarditis with cerebrovascular complications: a case report

Despite considerable improvements in therapeutic opportunities, infective endocarditis (IE) still suffers from a high morbidity and mortality rate, with septic embolism from valvular vegetations being one of its most dreadful complications. In complicated cases, early cardiac surgery can represent the greatest opportunity to improve the patient's prognosis, yet it encounters many issues that limit its indication. Herein, we present a case of an 80-year-old woman with native valve IE causing embolic ischemic stroke, delaying early cardiac surgery, and requiring complex multidisciplinary management. The case summarizes the pros and cons of the delayed surgery approach, which may allow a longer duration of antibiotic therapy and reduced risks of neurologic worsening but may enhance the risk of valve destruction, heart block, embolic complications, and death. This case reveals many critical aspects indicating early intervention despite very high surgical risk, providing insights into knowledge gaps and clinical needs for future research on this topic.