Early versus late surgical intervention or medical management for infective endocarditis: A systematic review and meta-analysis

Mahesh Anantha Narayanan, Toufik Mahfood Haddad, Andre C. Kalil, Arun Kanmanthareddy, Rakesh M. Suri, George Mansour, Christopher J. Destache, Janani Baskaran, Aryan N. Mooss, Tammy Wichman, Lee Morrow, Renuga Vivekanandan

Research output: Contribution to journalArticlepeer-review

46 Scopus citations

Abstract

Objective Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis. Methods PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed. Results A total of 21 studies were included. OR of allcause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, p<0.001) in unmatched groups and 0.41 (95% CI 0.31 to 0.54, p<0.001) in the propensity-matched groups (matched for baseline variables). For patients who had surgical intervention at 7 days or less, OR of all-cause mortality was 0.61 (95% CI 0.39 to 0.96, p=0.034) and in those who had surgical intervention within 8-20 days, the OR of mortality was 0.64 (95% CI 0.48 to 0.86, p=0.003) compared with conservative management. In propensity-matched groups, the OR of mortality in patients with surgical intervention at 7 days or less was 0.30 (95% CI 0.16 to 0.54, p<0.001) and in the subgroup of patients who underwent surgery between 8 and 20 days was 0.51 (95% CI 0.35 to 0.72, p<0.001). There was no significant difference in in-hospital mortality, embolisation, heart failure and recurrence of endocarditis between the overall unmatched cohorts. Conclusion The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis.

Original languageEnglish (US)
Pages (from-to)950-957
Number of pages8
JournalHeart
Volume102
Issue number12
DOIs
StatePublished - Jun 15 2016

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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