Cardiac surgery within 30 days in infective endocarditis with ICH linked to neurological deterioration

Intracranial haemorrhage (ICH) is one of the main causes of lack of surgery in patients with infective endocarditis (IE), despite the presence of surgical indications. They aimed to evaluate the impact of early surgery in patients with infective endocarditis (IE) and with Intracranial haemorrhage (ICH) on postoperative neurological deterioration and all‐cause mortality and to elucidate the risk of 30‐day mortality in patients who were denied surgery.

Three libraries (MEDLINE, EMBASE, and Cochrane Library) were assessed. The primary outcome was all‐cause mortality, and the secondary outcome was neurological deterioration. The inverse variance method and random model were performed.

The results of the study are:

They identified 16 studies including 355 patients. Nine studies examined the impact of surgical timing (early versus late) and were included in the meta‐analysis. Only one study examined the fate of patients with IE and with ICH who were treated conservatively despite having an indication for cardiac surgery, showing higher mortality rates than those who underwent surgery (11.8% versus 2.5%). We found no significant association between early surgery, regardless of its definition, and higher mortality (odds ratio [OR], 1.69; 95% CI, 0.95–3.02). Early surgery was associated with a higher risk for neurological deterioration (OR, 2.00; 95% CI, 1.10–3.65).

Thus, cardiac surgery for infective endocarditis (IE) within 30 days of Intracranial haemorrhage (ICH) was not associated with higher mortality, but with an increased rate of neurological deterioration. The 30‐day mortality in patients with infective endocarditis (IE) and with Intracranial haemorrhage (ICH) who were denied surgery has not yet been sufficiently investigated. This patient group should be analyzed in future studies in more detail.

Reference:

Surgical Timing in Patients with Infective Endocarditis and With Intracranial Hemorrhage: A Systematic Review and Meta‐Analysis by Rita Musleh et al. published in the Journal of the American Heart Association.

https://doi.org/10.1161/JAHA.121.024401