Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent literature suggests that surgery during index hospitalization may be performed safely without increased risk of adverse clinical outcomes. However, risk associated with specific surgical timing during index hospitalization remains unclear. Purpose The purpose of this meta-analysis is to assess the association of early surgery with mortality in patients with IE. Methods We performed a literature search for studies reporting an association between early surgery and study endpoints. The primary endpoint was in-hospital mortality. The secondary endpoint was long-term mortality. Early surgery was defined as surgery within 14 days of admission. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 15 studies with 2491 participants (900 with early surgery vs 1591 with delayed surgery) were included. The mean duration of follow-up was 33 months (ranging between 6 to 66 months). Early surgery was not associated with increased risk of in-hospital or long-term mortality compared to delayed surgery (OR 1.08, 95% CI 0.80, 1.46; P=0.63; OR 1.12, 95% CI 0.68, 1.86; P=0.65). Heterogeneity was low: Chi2 = 7.85, I2 = 0%. Subgroup analysis by time to surgery demonstrated that early surgery was not associated with increased risk of in-hospital mortality for surgeries performed within 2 days, 7 days, or 14 days of hospitalization (OR 0.87, 95% CI 0.58, 1.32; P=0.51; OR 1.06, 95% CI 0.78, 1.43; P=0.72; OR 0.51, 95% CI 0.21, 1.23; P=0.13). Heterogeneity was low: Chi2 = 4.84, I2 = 0%. Conclusions Early surgery performed within 14 days of initial hospitalization is not associated with increased risk of in-hospital mortality or long-term mortality compared to delayed surgery.

Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent literature suggests that early surgery may be performed without increased risk of mortality, however this association in patients with IE complicated by cerebral infarction (CI) remains unclear. Purpose The purpose of this meta-analysis is to assess the association between early surgery after CI and mortality in patients with IE complicated by CI. Methods We performed a literature search for studies reporting an association between early surgery and study endpoints. The primary endpoint was in-hospital mortality. The secondary endpoint was long-term mortality. Early surgery was defined as surgery within 14 days of CI event. Conventional therapy was defined as surgery after 14 days of CI event. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 6 studies with 747 participants (318 with early surgery vs 429 with conventional therapy) were included. The mean duration of follow-up was 36 months (ranging between 12 to 62 months). Early surgery was not associated with increased risk of in-hospital or long-term mortality compared to conventional therapy (OR 1.21, 95% CI 0.59, 2.49; P=0.6; OR 0.65, 95% CI 0.06, 7.22; P=0.72). Heterogeneity was moderate: Chi2 = 7.26, I2 = 45%. Conclusions Early surgery within 14 days of CI is not associated with increased risk of in-hospital or long-term mortality in patients with IE complicated by CI.

Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent studies suggests that surgery during index hospitalization may be performed without increased risk of mortality. However, differences in this association in patients with native valve IE and prosthetic valve IE remain unclear. Purpose The purpose of this meta-analysis is to explore differences in the association between early surgery and mortality in patients with native valve IE and prosthetic valve IE. Methods We performed a literature search for studies reporting an association between early surgery and study endpoints in patients with either native valve IE or prosthetic valve IE. The primary endpoint was in-hospital mortality. The secondary endpoints was long-term mortality. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Studies reporting mixed native and prosthetic valve populations were excluded. Results A total of 10 studies with 5493 participants (2505 with early surgery vs 2988 with conventional therapy) were included. The mean duration of follow-up was 55 months (ranging between 12 to 120 months). Early surgery in patients with native valve IE was associated with lower risk of in-hospital mortality (OR 0.48, 95% CI 0.28, 0.83; p<0.01). Early surgery in patients with native valve IE was associated with lower risk of long-term mortality, however this effect was primarily driven by a single study (OR 0.26, 95% CI 0.08, 0.83; p=0.02). Early surgery in patients with prosthetic valve IE was not significantly associated with risk of in-hospital mortality, however there is a trend toward lower risk (OR 0.77, 95% CI 0.58, 1.02; p=0.07). There was not enough studies reporting long-term outcomes to assess the association between early surgery and long-term mortality in patients with prosthetic valve IE Conclusions Early surgery is associated with lower risk of in-hospital mortality in patients with native valve IE and is not associated with increased risk of mortality in patients with prosthetic valve IE. Further high-quality studies are needed to elucidate the association between early surgery and long-term outcomes in both patients with native valve IE and prosthetic valve IE.

Funding Acknowledgements Type of funding sources: None. Background Infective endocarditis (IE) is a disease associated with high risk of morbidity and mortality. Recent literature suggests that surgery during index hospitalization may be performed safely without increased risk of mortality. However, the risk of post-operative complications remains unclear. Purpose The purpose of this meta-analysis is to assess the association of early surgery with post-operative complications as compared to delayed surgery in patients with IE. Methods We performed a literature search for studies reporting an association between early surgery and study endpoints. The primary endpoint was post-operative neurological complications. The secondary endpoints were post-operative systemic embolic events, recurrence of IE, and need for reoperation. Early surgery was defined as surgery within 14 days of admission. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 11 studies with 1857 participants (634 with early surgery vs 1223 with delayed surgery) were included. The mean duration of follow-up was 39 months (ranging between 6 to 66 months). Early surgery compared to delayed surgery was not associated with increased risk of post-operative neurological complications (OR 1.01, 95% CI 0.55, 1.85; P=0.98). Heterogeneity was low: Chi2 = 2.93, I2 = 0%. Early surgery compared to delayed surgery was not associated with increased risk for post-operative systemic embolic events, recurrence of IE, or need for reoperation (OR 0.98, 95% CI 0.6, 1.61; p=0.94; OR 1.66, 95% CI 0.83, 3.33; p=0.15; OR 2.18, 95% CI 0.41, 11.69; p=0.36). Conclusions Early surgery performed within 14 days of initial hospitalization is not associated with increased risk of post-operative complications compared to delayed surgery.