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The effect of early surgical intervention on mortality in patients with infective endocarditis (IE) remains controversial. We conducted a systematic review and meta–analysis of available studies to evaluate the clinical outcome of early surgery compared with conventional medical therapy or conservative management for IE.
The authors searched the PubMed, CENTRAL, CINAHL, and EMBASE databases for related studies from 1966 to October, 2012. Studies comparing early surgery with conventional or conservative medical therapy were included. Early surgery was defined as surgical intervention with valve repair or replacement within two weeks of IE diagnosis. The primary outcome assessed was risk of all–cause mortality. We used a random effects model to evaluate outcomes between early surgery versus conventional/conservative strategies. The methodological quality of the studies was assessed. Statistical analysis was done with Review Manager V5.1.
Five studies that satisfied the inclusion criteria were included in the final analysis. Patient randomized to early surgery had significantly less all–cause mortality compared to those receiving conventional medical treatment or conservative therapy (Risk ratio, 0.51; 95% confidence interval, 0.34 to 0.76, p=0.001).
As compared with conventional medical therapy or conservative approach, early surgery significantly reduced the mortality in patients with infective endocarditis.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Optimal Management of Tricuspid Regurgitation and Trends in the Treatment of Endocarditis
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 1284–78
- 2013 American College of Cardiology Foundation