Department of Cardiothoracic Surgery Friedrich-Schiller-University Jena Jena Germany.
Institute for Infectious Diseases and Infection Control, Friedrich-Schiller-University Jena Jena Germany.
J Am Heart Assoc. 2024 Apr 2;13(7):e033404. doi: 10.1161/JAHA.123.033404. Epub 2024 Mar 27.
Infective endocarditis represents a life-threatening disease with high mortality rates. A fraction of patients receives exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. The aim of the present study is to compare outcomes in patients with infective endocarditis and indication for surgical therapy in those who underwent or did not undergo valve surgery.
Three databases were systematically assessed. A pooled analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies with longer follow-up comparing conservative and surgical treatment was performed. A landmark analysis to further elucidate the effect of surgical intervention on mortality was carried out. Four studies with 3003 patients and median follow-up time of 7.6 months were included. Overall, patients with an indication for surgery who were surgically treated had a significantly lower risk of mortality compared with patients who received conservative treatment (hazard ratio [HR], 0.27 [95% CI, 0.24-0.31], <0.001). The survival analysis in the first year showed superior survival for patients who underwent surgery when compared with those who did not at 1 month (87.6% versus 57.6%; HR, 0.31 [95% CI, 0.26-0.37], <0.01), at 6 months (74.7% versus 34.6%) and at 12 months (73.3% versus 32.7%).
Based on the findings of this study-level meta-analysis, patients with infective endocarditis and formal indication for surgical intervention who underwent surgery are associated with a lower risk of short- and long-term mortality when compared with conservative treatment.
感染性心内膜炎是一种危及生命的疾病，死亡率很高。尽管符合手术治疗标准，但由于合并症和手术风险高，仍有一部分患者仅接受保守的抗生素治疗。本研究旨在比较有手术治疗指征的感染性心内膜炎患者在接受和未接受瓣膜手术治疗的患者的结局。
系统评估了三个数据库。对具有较长随访时间的研究中，通过 Kaplan-Meier 重建时间事件数据进行荟萃分析，比较了保守治疗和手术治疗的结果。进行了一个里程碑分析，以进一步阐明手术干预对死亡率的影响。纳入了四项研究，共 3003 例患者，中位随访时间为 7.6 个月。总体而言，有手术指征且接受手术治疗的患者的死亡率明显低于接受保守治疗的患者（风险比 [HR]，0.27 [95%CI，0.24-0.31]，<0.001）。在第一年的生存分析中，与未接受手术的患者相比，接受手术的患者的生存率在 1 个月（87.6%比 57.6%；HR，0.31 [95%CI，0.26-0.37]，<0.01）、6 个月（74.7%比 34.6%）和 12 个月（73.3%比 32.7%）时均更高。
基于这项研究水平荟萃分析的结果，对于有手术治疗指征且接受手术治疗的感染性心内膜炎患者，与保守治疗相比，短期和长期死亡率较低。
