Abstract 354: The Effect Of Early Surgery on Outcomes in Infective Endocarditis- A Meta- Analysis of 25,732 Patients

Abstract

Despite a rising incidence of infective endocarditis (IE), its associated mortality remains high. It is estimated that at least 30% of patients with IE undergo surgery, however data on outcomes of outcomes associated with timing of surgical intervention in this setting is limited. Existing literature mainly consists of observational studies with conflicting results, and current guidelines (ACC/ AHA and Society of Thoracic Surgeons) base recommendations largely on small retrospective studies and expert opinion. We sought to determine the effect of early surgery on outcomes after IE by performing the first comprehensive meta- analysis on the subject. A comprehensive literature search using PubMed (MEDLINE) was performed using keywords “endocarditis”, “surgery”, “mortality” and “outcome”. Early surgery was defined as surgical intervention performed during index hospitalization. Primary outcome of interest was all-cause mortality. Secondary outcomes included incidence of recurrent endocarditis and embolic phenomenon. Of 117 identified studies, 36 met the inclusion criteria (25,732 patients). Data on baseline characteristics and outcomes of interest were extracted. Meta-analysis was performed using Review Manager Version 5.0 (Cochrane Collaboration). Effect sizes for outcomes of interest were estimated using odds ratio (OR) and 95% confidence intervals (CI). Given the inherent heterogeneity among included studies, results from the random effects model are reported. Of the included 25,732 patients, 7,835 underwent early surgery compared to 17,537 who received conventional treatment. A significant reduction in both, short and long term mortality in patients who underwent early surgery OR 0.58 (95% CI 0.47-0.70; p = <0.001) and OR 0.49 (95% CI 0.37-0.65; p = 0.001) respectively was seen. The incidence of recurrent endocarditis or embolic phenomenon did not differ between the two groups. This is the first comprehensive meta-analysis to examine the impact of early surgery on outcomes in patients with IE. Our results indicate that early surgery is associated with a significant reduction in all-cause mortality in patients with IE, without an increase in incidence of recurrent endocarditis. These findings are of clinical significance given paucity of quality data on the subject.