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Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a
Yujiro Yokoyama1, Taichiro Goto2
1Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA.
Insights
For infective endocarditis with cerebral infarction, early or late surgery shows similar mid- to long-term mortality and recurrence rates. Individualized patient assessment is key for optimal surgical timing.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Cerebral infarction (CI) is a frequent and severe complication of infective endocarditis (IE).
- The optimal timing for surgical intervention in IE patients with neurological complications is debated.
- Previous meta-analyses have not assessed mid- to long-term outcomes related to surgical timing.
Purpose of the Study:
- To compare mid- to long-term outcomes of early versus late surgery in patients with IE and neurological complications.
- To evaluate the impact of surgical timing on all-cause mortality and recurrence rates.
- To provide evidence-based guidance on surgical timing for IE with CI.
Main Methods:
- A meta-analysis of observational studies comparing early and late surgery in IE patients with neurological complications.
- Inclusion of studies reporting all-cause mortality and recurrence as primary and secondary endpoints.
- Extraction and pooled analysis of hazard ratios (HRs) with 95% confidence intervals (CIs).
Main Results:
- Five observational studies with a total of 624 patients were included.
- No significant difference in all-cause mortality between early and late surgery groups (HR: 0.90; P=0.10).
- Similar recurrence rates were observed in both surgical timing groups (HR: 1.86; P=0.43).
Conclusions:
- Mid- to long-term mortality and recurrence rates are comparable for early and late surgery in IE patients with CI.
- Surgical timing decisions for IE with neurological complications should be individualized.
- Further research may be needed to refine patient selection criteria for optimal surgical timing.
Background:
Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications.
Methods:
All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study.
Results:
Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]] = 0.90 [0.49-1.64]; P = 0.10; I2 = 49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI] = 1.86 [0.76-4.52]; P = 0.43; I2 = 0%).
Conclusions:
Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.
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