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Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis

BACKGROUND: Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previou...

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Autores principales: Yokoyama, Yujiro, Goto, Taichiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992857/
https://www.ncbi.nlm.nih.gov/pubmed/33766081
http://dx.doi.org/10.1186/s13019-021-01425-x
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author Yokoyama, Yujiro
Goto, Taichiro
author_facet Yokoyama, Yujiro
Goto, Taichiro
author_sort Yokoyama, Yujiro
collection PubMed
description BACKGROUND: Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications. METHODS: All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. RESULTS: Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]] = 0.90 [0.49–1.64]; P = 0.10; I(2) = 49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI] = 1.86 [0.76–4.52]; P = 0.43; I(2) = 0%). CONCLUSIONS: Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.
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spelling pubmed-79928572021-03-25 Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis Yokoyama, Yujiro Goto, Taichiro J Cardiothorac Surg Research Article BACKGROUND: Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications. METHODS: All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. RESULTS: Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]] = 0.90 [0.49–1.64]; P = 0.10; I(2) = 49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI] = 1.86 [0.76–4.52]; P = 0.43; I(2) = 0%). CONCLUSIONS: Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis. BioMed Central 2021-03-25 /pmc/articles/PMC7992857/ /pubmed/33766081 http://dx.doi.org/10.1186/s13019-021-01425-x Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Yokoyama, Yujiro
Goto, Taichiro
Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis
title Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis
title_full Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis
title_fullStr Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis
title_full_unstemmed Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis
title_short Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis
title_sort midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992857/
https://www.ncbi.nlm.nih.gov/pubmed/33766081
http://dx.doi.org/10.1186/s13019-021-01425-x
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