Optimal timing for early surgery in infective endocarditis: a meta-analysis

Abstract

To systematically review early surgery and the optimal timing of surgery in patients with infective endocarditis (IE), a search for foreign and domestic articles on cohort studies about the association between early surgery and infective endocarditis published from inception to January 2015 was conducted in the PubMed, EMBASE, Chinese Biomedical Literature (CBM), Wanfang and Chinese National Knowledge Infrastructure (CNKI) databases. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality of the method of the included studies was assessed. Then, the meta-analysis was performed using the Stata 12.0 software. Sixteen cohort studies, including 8141 participants were finally included. The results of the meta-analysis revealed that, compared with non-early surgery, early surgery in IE lowers the incidence of in-hospital mortality [odds ratio (OR) = 0.57, 95% confidence interval (CI) (0.42, 0.77); P = 0.000, I(2) = 73.1%] and long-term mortality [OR = 0.57, 95% CI (0.43, 0.77); P = 0.001, I(2) = 67.4%]. Further, performing operation within 2 weeks had a more favourable effect on long-term mortality [OR = 0.63, 95% CI (0.41, 0.97); P = 0.192, I(2) = 39.4%] than non-early surgery. In different kinds of IE, we found that early surgery for native valve endocarditis (NVE) had a lower in-hospital [OR = 0.46, 95% CI (0.31, 0.69); P = 0.001, I(2) = 73.0%] and long-term [OR = 0.57, 95% CI (0.40, 0.81); P = 0.001, I(2) = 68.9%] mortality than the non-early surgery group. However, for prosthetic valve endocarditis (PVE), in-hospital mortality did not differ significantly [OR = 0.83, 95% CI (0.65, 1.06); P = 0.413, I(2) = 0.0%] between early and non-early surgery. We concluded that early surgery was associated with lower in-hospital and long-term mortality compared with non-early surgical treatment for IE, especially in NVE. However, the optimal timing of surgery remains unclear. Additional larger prospective clinical trials will be required to clarify the optimal timing for surgical intervention and determine its efficacy in PVE.

Clinical and prognostic differences between methicillin-resistant and methicillin-susceptible Staphylococcus aureus infective endocarditis

“…Transplantation* (3 kidney, 1 heart, 1 bone marrow). Postponed: conducted ≥1 month of hospitalization first 2 weeks rather than later in cases of native IE (OR = 0.46, 95% CI [0.31, 0.69]; p = 0.001) but not in cases of prosthetic IE (OR = 0.83, 95% CI [0.65, 1.06]; p = 0.413) [37]. Another study found no reduction in one-year mortality in patients with S. aureus IE on prosthetic valve when the surgery was performed during the first 60 days of hospitalization rather than later (risk ratio, 0.67 [95% CI: 0.39-1.15]; p = 0.15).…”

Preoperative False-Negative Transthoracic Echocardiographic Results in Native Valve Infective Endocarditis Patients: A Retrospective Study from 2001 To 2018

“…The mortality of patients who underwent surgery was almost one-sixth of that of patients who did not undergo surgery in our study. Several previous studies pointed out that surgery was independently associated with a lower risk of inhospital mortality [13] [14,15] . We previously performed a multivariate analysis in 313 cases of IE (including prosthetic valve endocarditis) [11] and identi ed intravenous drug addiction, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insu ciency, left-sided endocarditis, and early surgery as independent predictors of in-hospital mortality.…”

A changing profile of infective endocarditis at a tertiary hospital in China: A retrospective study from 2001 to 2018

“…Early surgery has been proved to be associated with a significantly lower in-hospital mortality rate as compared to medical therapy [49,50] Mortality of patients who underwent surgery was one sixth of that of patients who did not have the surgery. In our study, up to 59.7% of our patients underwent surgery during hospitalization, which is similar to other regions like Brazil (52.4-55.0%) [43] , Spain (57.0%) and…”