Early versus late surgical intervention or medical management for infective endocarditis: A systematic review and meta-analysis

Mahesh Anantha Narayanan, Toufik Mahfood Haddad, Andre C Kalil, Arun Kanmanthareddy, Rakesh M. Suri, George Mansour, Christopher J. Destache, Janani Baskaran, Aryan N. Mooss, Tammy O Wichman, Lee Morrow, Renuga Vivekanandan

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31 Citations (Scopus)

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 allcause 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.

Original languageEnglish (US)
Pages (from-to)950-957
Number of pages8
JournalHeart
Volume102
Issue number12
DOIs
StatePublished - Jun 15 2016

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Endocarditis
Meta-Analysis
Mortality
Research Design
Hospital Mortality
PubMed
Observational Studies
Randomized Controlled Trials
Heart Failure
Databases
Prospective Studies
Morbidity
Recurrence
Conservative Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Narayanan, M. A., Haddad, T. M., Kalil, A. C., Kanmanthareddy, A., Suri, R. M., Mansour, G., ... Vivekanandan, R. (2016). Early versus late surgical intervention or medical management for infective endocarditis: A systematic review and meta-analysis. Heart, 102(12), 950-957. https://doi.org/10.1136/heartjnl-2015-308589

Early versus late surgical intervention or medical management for infective endocarditis : A systematic review and meta-analysis. / Narayanan, Mahesh Anantha; Haddad, Toufik Mahfood; Kalil, Andre C; Kanmanthareddy, Arun; Suri, Rakesh M.; Mansour, George; Destache, Christopher J.; Baskaran, Janani; Mooss, Aryan N.; Wichman, Tammy O; Morrow, Lee; Vivekanandan, Renuga.

In: Heart, Vol. 102, No. 12, 15.06.2016, p. 950-957.

Research output: Contribution to journalArticle

Narayanan, MA, Haddad, TM, Kalil, AC, Kanmanthareddy, A, Suri, RM, Mansour, G, Destache, CJ, Baskaran, J, Mooss, AN, Wichman, TO, Morrow, L & Vivekanandan, R 2016, 'Early versus late surgical intervention or medical management for infective endocarditis: A systematic review and meta-analysis', Heart, vol. 102, no. 12, pp. 950-957. https://doi.org/10.1136/heartjnl-2015-308589
Narayanan, Mahesh Anantha ; Haddad, Toufik Mahfood ; Kalil, Andre C ; Kanmanthareddy, Arun ; Suri, Rakesh M. ; Mansour, George ; Destache, Christopher J. ; Baskaran, Janani ; Mooss, Aryan N. ; Wichman, Tammy O ; Morrow, Lee ; Vivekanandan, Renuga. / Early versus late surgical intervention or medical management for infective endocarditis : A systematic review and meta-analysis. In: Heart. 2016 ; Vol. 102, No. 12. pp. 950-957.
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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 allcause 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.",
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AU - Narayanan, Mahesh Anantha

AU - Haddad, Toufik Mahfood

AU - Kalil, Andre C

AU - Kanmanthareddy, Arun

AU - Suri, Rakesh M.

AU - Mansour, George

AU - Destache, Christopher J.

AU - Baskaran, Janani

AU - Mooss, Aryan N.

AU - Wichman, Tammy O

AU - Morrow, Lee

AU - Vivekanandan, Renuga

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N2 - 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 allcause 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.

AB - 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 allcause 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.

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