Conservative Versus Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication—Meta‐Analysis of Reconstructed Time‐to‐Event Data

GND
1242046895
ORCID
0000-0001-5697-2659
Affiliation
Department of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena Germany
Caldonazo, Tulio;
GND
132154706
ORCID
0000-0003-2999-6131
Affiliation
Institute for Infectious Diseases and Infection Control, Friedrich‐Schiller‐University Jena Jena Germany
Hagel, Stefan;
GND
120602571
ORCID
0000-0002-6411-909X
Affiliation
Department of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena Germany
Doenst, Torsten;
GND
1180648404
ORCID
0000-0001-5886-3472
Affiliation
Department of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena Germany
Kirov, Hristo;
ORCID
0000-0001-5356-2996
Affiliation
Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh PA USA
Sá, Michel Pompeu;
ORCID
0000-0001-8421-0686
Affiliation
Department of Cardiovascular Sciences KU Leuven Leuven Belgium
Jacquemyn, Xander;
ORCID
0000-0001-7735-9474
Affiliation
Division of Cardiothoracic Surgery University of North Carolina Chapel Hill NC USA
Tasoudis, Panagiotis;
GND
133832325
ORCID
0000-0001-6543-4684
Affiliation
Division of Cardiology, Department of Internal Medicine Friedrich‐Schiller‐University Jena Jena Germany
Franz, Marcus;
GND
1062970365
Affiliation
Department of Cardiothoracic Surgery Friedrich‐Schiller‐University Jena Jena Germany
Diab, Mahmoud

Background: Infective endocarditis represents a life‐threatening disease with high mortality rates. A fraction of patients receives exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. The aim of the present study is to compare outcomes in patients with infective endocarditis and indication for surgical therapy in those who underwent or did not undergo valve surgery.

Methods and Results: Three databases were systematically assessed. A pooled analysis of Kaplan–Meier–derived reconstructed time‐to‐event data from studies with longer follow‐up comparing conservative and surgical treatment was performed. A landmark analysis to further elucidate the effect of surgical intervention on mortality was carried out. Four studies with 3003 patients and median follow‐up time of 7.6 months were included. Overall, patients with an indication for surgery who were surgically treated had a significantly lower risk of mortality compared with patients who received conservative treatment (hazard ratio [HR], 0.27 [95% CI, 0.24–0.31], P <0.001). The survival analysis in the first year showed superior survival for patients who underwent surgery when compared with those who did not at 1 month (87.6% versus 57.6%; HR, 0.31 [95% CI, 0.26–0.37], P <0.01), at 6 months (74.7% versus 34.6%) and at 12 months (73.3% versus 32.7%).

Conclusions: Based on the findings of this study‐level meta‐analysis, patients with infective endocarditis and formal indication for surgical intervention who underwent surgery are associated with a lower risk of short‐ and long‐term mortality when compared with conservative treatment.

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License Holder: Copyright © 2024 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell

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