Early or Delayed Surgery for Infective Endocarditis Complicated by Cerebral Embolism: a Meta-analysis

Background: Surgery is recommended for infective endocarditis patients who develop cerebral embolism, however the optimal timing of surgery remains controversial. In this meta-analysis, we compared the outcomes of early and delayed cardiac surgery for infective endocarditis in this setting. Methods: PubMed, MEDLINE, Embase, Cochrane and Scopus databases from 1 January 1980 to 30 June 2016 were searched for original studies. Two authors evaluated these studies for inclusion independently, then extracted and pooled data using random-effects models. Results: Amongst 2,423 papers obtained from the search, 23 full-texts were reviewed, and 6 studies totalling 701 patients were included for analyses. Rates and pooled odds ratio (95% confidence interval) for operative mortality of early or late surgery set at 7 days were 13.5% vs 10.8%, 1.40 (0.61-3.02); 14 days were 20.7% vs 13.0%, 1.95 (0.95-4.01). Pooled odds ratio of early surgery for long-term mortality was 2.95 (0.35-25.0); and for neurological events, embolic event was 1.22 (0.33-4.56) and intracranial bleeding 1.55 (0.16-15.32). Conclusion: Although early surgery was not associated with statistically higher rates of mortality or neurological events it does need to be cautiously performed. Data is limited and larger and randomised studies would help to determine the optimal timing.