Early surgery to prevent embolic events in patients with infective endocarditis: a comprehensive review

Sikander Tajik Nielsen, Katra Hadji-Turdeghal, Peter Laursen Graversen, Lauge Østergaard, Morten Holdgaard Smerup, Lars Køber, Emil Loldrup Fosbøl*

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftReviewForskningpeer review

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Abstract

Background
Infective endocarditis (IE) is a dangerous and lethal illness with high mortality rates. One of the main indications for surgery according to the guidelines is prevention of embolic events. However, uncertainty remains concerning the timing of surgery and the effect of early surgery in combination with antibiotic therapy versus antibiotic therapy alone in IE patients with a vegetation size > 10 mm.

Methods
We conducted a comprehensive review by searching the PubMed, MEDLINE, and EMbase databases. Titles and abstracts were screened, and studies of interest were selected for full-text assessment. Studies were selected for review if they met the criteria of comparing surgical treatment + antibiotic therapy to antibiotic therapy alone in patients with vegetations > 10 mm.

Results
We found 1,503 studies through our database search; nine of these were eligible for review, with a total number of 3,565 patients. Median age was 66 years (range: 17–80) and the median percentage of male patients was 65.6% (range: 61.8 − 71.4%). There was one randomised controlled trial, one prospective study, and seven retrospective studies. Seven studies found surgery + antibiotic therapy to be associated with better outcomes in patients with IE and vegetations > 10 mm, one of them being the randomised trial [hazard ratio = 0.10; 95% confidence interval 0.01–0.82]. Two studies found surgery + antibiotic therapy was associated with poorer outcomes compared with antibiotic therapy alone.

Conclusion
Overall, data vary in quality due to low numbers and selection bias. Evidence is conflicting, yet suggest that surgery + antibiotic therapy is associated with better outcomes in patients with IE and vegetations > 10 mm for prevention of emboli. Properly powered randomised trials are warranted.
OriginalsprogEngelsk
Artikelnummer463
TidsskriftJournal of Cardiothoracic Surgery
Vol/bind19
Udgave nummer1
Antal sider9
ISSN1749-8090
DOI
StatusUdgivet - 2024

Bibliografisk note

Publisher Copyright:
© The Author(s) 2024.

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