Article Text

PDF
Original article
Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis
  1. Mahesh Anantha Narayanan1,
  2. Toufik Mahfood Haddad1,
  3. Andre C Kalil2,
  4. Arun Kanmanthareddy3,
  5. Rakesh M Suri4,
  6. George Mansour1,
  7. Christopher J Destache5,
  8. Janani Baskaran6,
  9. Aryan N Mooss3,
  10. Tammy Wichman7,
  11. Lee Morrow7,
  12. Renuga Vivekanandan8
  1. 1Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
  2. 2Division of Infectious Diseases, University of Nebraska School of Medicine, Omaha, Nebraska, USA
  3. 3Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
  4. 4Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
  5. 5School of Pharmacy & Health Professions and School of Medicine, Creighton University, Omaha, Nebraska, USA
  6. 6University of Texas Southwestern at Dallas, Dallas, Texas, USA
  7. 7Division of Pulmonary Critical Care and Sleep Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
  8. 8Division of Infectious Diseases, Creighton University School of Medicine, Omaha, Nebraska, USA
  1. Correspondence to Dr Mahesh Anantha Narayanan, Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE 68154, USA; mahesh_maidsh{at}yahoo.com

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 all-cause 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.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.