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Optimal timing for early surgery in infective endocarditis: a meta-analysis
Fuxiang Liang1, Bing Song2, Ruisheng Liu1
1The First Clinical College of Lanzhou University, Lanzhou University, Lanzhou, China Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China.
Interactive Cardiovascular and Thoracic Surgery
|December 19, 2015
Summary
Early surgery for infective endocarditis (IE) significantly reduces both in-hospital and long-term mortality. This benefit is particularly pronounced in native valve endocarditis (NVE), though optimal timing requires further investigation.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Clinical Epidemiology
Background:
- Infective endocarditis (IE) is a serious infection of the heart's inner lining or valves.
- The role of early surgical intervention in improving outcomes for IE patients remains a critical clinical question.
- Existing research presents varied findings regarding the optimal timing and efficacy of surgery in different IE subtypes.
Purpose of the Study:
- To systematically review and meta-analyze cohort studies evaluating the association between early surgery and mortality in infective endocarditis.
- To determine the impact of early surgical intervention on in-hospital and long-term mortality.
- To explore the differential effects of early surgery in native valve endocarditis (NVE) versus prosthetic valve endocarditis (PVE).
Main Methods:
- Systematic literature search of PubMed, EMBASE, CBM, Wanfang, and CNKI databases for cohort studies up to January 2015.
- Inclusion and exclusion criteria applied for study selection, followed by data extraction and quality assessment.
- Meta-analysis performed using Stata 12.0 on data from 16 cohort studies involving 8141 participants.
Main Results:
- Early surgery in IE patients was associated with significantly lower in-hospital mortality (OR = 0.57, 95% CI [0.42, 0.77]) and long-term mortality (OR = 0.57, 95% CI [0.43, 0.77]) compared to non-early surgery.
- Surgery within 2 weeks showed a trend towards better long-term mortality outcomes (OR = 0.63, 95% CI [0.41, 0.97]).
- Early surgery demonstrated significant mortality benefits in native valve endocarditis (NVE) but not in prosthetic valve endocarditis (PVE).
Conclusions:
- Early surgical intervention in infective endocarditis is linked to reduced in-hospital and long-term mortality, particularly for NVE.
- The optimal timing for surgical intervention in IE, especially for PVE, requires further clarification.
- Larger prospective clinical trials are needed to definitively establish the optimal surgical timing and confirm efficacy in PVE.
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