Conservative vs. Surgical Therapy in Patients With Infective Endocarditis and Surgical Indication: Meta‐Analysis

Some patients with infective endocarditis receive exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. Hence, this study aimed to compare the outcomes in patients with infective endocarditis and a surgical indication in those who underwent or did not undergo valve surgery. To this end, the authors performed a pooled analysis of Kaplan-Meier derived reconstructed time‐to‐event data from studies comparing conservative and surgical treatment. Four studies with a total of 3,003 patients and a 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 percent CI, 0.24–0.31], P <0.001). Survival was superior among patients who underwent surgery when compared with those who did not, at one month (87.6 percent versus 57.6 percent; HR, 0.31 [95 percent CI, 0.26–0.37], P <0.01), at 6 months (74.7 percent versus 34.6 percent), and at 12 months (73.3 percent versus 32.7 percent).