Surgery in current therapy for infective endocarditis

Stuart J Head¹, M Mostafa Mokhles¹, Ruben LJ Osnabrugge^1,2, Ad JJC Bogers¹, A Pieter Kappetein^1
1Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; ²Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands

Abstract: The introduction of the Duke criteria and transesophageal echocardiography has improved early recognition of infective endocarditis but patients are still at high risk for severe morbidity or death. Whether an exclusively antibiotic regimen is superior to surgical intervention is subject to ongoing debate. Current guidelines indicate when surgery is the preferred treatment, but decisions are often based on physician preferences. Surgery has shown to decrease the risk of short-term mortality in patients who present with specific symptoms or microorganisms; nevertheless even then it often remains unclear when surgery should be performed. In this review we i) systematically reviewed the current literature comparing medical to surgical therapy to evaluate if surgery is the preferred option, ii) performed a meta-analysis of studies reporting propensity matched analyses, and iii), briefly summarized the current indications for surgery.

Keywords: endocarditis, surgery, antibiotics, review, meta-analysis, propensity analysis, mortality, complications