Surgery for Infective Endokarditis in Patients with a Recent Stroke: Results from the Multi-Centre CROSS Registry

All articles of this category (opens in new window) Background: Embolic complications of valve endocarditis are an indication for surgery. However, recent strokes may cause disturbances in blood–brain barrier, and there is repeated discussion whether these patients have a higher risk of stroke on extracorporeal circulation with full anticoagulation using heparin. This prompted us to analyze our experience in patients with a recent stroke in our multi-center registry. Methods: The CROSS-Registry is a multi-center registry of endocarditis patients active at three German institutions. Four hundred and eighteen patients underwent surgery from 2022 to 2025; of these, 241 had sufficient data for analysis. Thirty-nine patients (16.1%) had a recent stroke 72 hours (28.2% (11/39) vs. 8.9% (18/202), p = 0.02) was more frequent in +stroke patients. In-hospital mortality (20.5% (8/39) vs.20.8% (42/202), p = 0.99) was not different. Conclusion: Recent stroke is common in patients with infective endocarditis. A history of a recent stroke is associated with the occurrence of postoperative strokes. However, mortality rates did not differ. In patients with mobile vegetations and recent stroke, the risk of recurrent emboli has to be weighed against the risk of surgery by a dedicated interdisciplinary endocarditis team. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany