One clinical quandary is whether early valve surgery can be safely performed within 7 days after a stroke or if it is better to postpone surgery for at least 1 week. No randomized trials have addressed this conundrum. The high rates of postoperative mor- bidity and mortality seen in earlier studies265 267 have resulted in a reluctance to refer patients with IE and acute stroke for imme- diate valve surgery. However, these initial studies included a limited number of patients, and risk adjustments were not per- formed. The largest early series of operated patients with cere- bral complications included 181 patients.267 Hospital mortality rates as a function of the interval between evidence of cerebral infarction to cardiac surgery were 66.3% when surgery was per- formed within 24 hours of stroke and gradually decreased every week to 7.0% with surgery >4 weeks after stroke. Investigations have suggested better outcomes for IE patients with ischemic stroke who undergo early cardiac sur- Ruttmann et al270 analyzed 65 patients who under- went cardiac surgery after cardioembolic (embolic) stroke (median time, 4 days; range, 0 38 days). Surgery in this time frame was not associated with worse patient outcomes. Fifty of the 61 patients (81.9%) with CT-verified preopera- tive stroke survived cardiac surgery. Latency between the neurological event and cardiac surgery was not a significant factor with respect to the perioperative neurological compli- cation rate or the postoperative neurological recovery rate. Full neurological recovery was achieved in 70% of 50 stroke patients. Other studies6 8 suggest that the risk of neurologi- cal deterioration during cardiac surgery after a stroke is lower than previously assumed, particularly in patients with silent cerebrovascular emboli. 