Early vs Late Surgery for Patients With Endocarditis and Neurological Injury: A Systematic Review and Meta-analysis

The Canadian Journal of Cardiology
Derrick Y TamJan O Friedrich

Abstract

Surgical timing in infective endocarditis (IE) with preoperative neurological events remains controversial. The relevant society guidelines are each on the basis of a small number of observational studies. This meta-analysis was designed to search the available literature broadly and assess the weight of available evidence as comprehensively as possible. We searched MEDLINE and EMBASE to April 2018 for studies that compared mortality or neurological exacerbation in early vs late surgery for IE complicated by neurological events. Random effects meta-analysis was performed. Twenty-seven observational studies (25 unadjusted, n = 879; 2 adjusted, n = 451) met inclusion criteria. Using early and late thresholds defined in each study (7 or 14 days), early surgery in ischemic or hemorrhagic stroke was associated with elevated perioperative mortality vs late surgery (pooled relative risk [RR], 1.74; 95% confidence interval, 1.34-2.25; P < 0.0001; I2 = 0%) and greater neurological exacerbation (RR, 2.09; 95% confidence interval, 1.32-3.32; P = 0.002; I2 = 33%). In subgroup analysis, for ischemic stroke, early surgery before 7 vs before 14 days exhibited similar perioperative mortality and neurological exacerbation. For hemorrhagic strok...Continue Reading

Citations

Mar 31, 2019·Current Neurology and Neuroscience Reports·Filipa Dourado SoteroJosé M Ferro
Oct 10, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Mahmoud DiabAlbrecht Günther
Apr 23, 2020·European Journal of Internal Medicine·Valentina ScheggiPier Luigi Stefàno
Mar 6, 2021·European Heart Journal Supplements : Journal of the European Society of Cardiology·Nikolaos BonarosElfriede Ruttmann-Ulmer
Oct 16, 2020·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Elfriede RuttmannNikolaos Bonaros
Apr 9, 2021·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Emily ShihJ Michael DiMaio
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May 22, 2019·La Presse médicale·Bruno HoenUNKNOWN l’Endocarditis Team du CHU de Nancy
Apr 29, 2021·Scientific Reports·Caleb R MatthewsLawrence S Lee

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