Early surgery for infective endocarditis lacks robust randomized trial evidence compared to conventional treatment, with current guidelines relying primarily on expert opinion.
Does early surgery reduce mortality and complications in patients with infective endocarditis compared to conventional treatment?
Current evidence on the optimal timing of surgery for infective endocarditis is limited to expert opinion, highlighting the need for robust randomized trials to clarify guideline recommendations.
The most appropriate strategy and timing for surgery in infective endocarditis (IE) remains an argument of debate. Despite some authors promote the adoption of an early surgical approach (within 48 hours) to limit mortality and complications, no robust randomized trials are available on this argument and the evidence on this subject remain at the "expert opinion" level. Additionally, the different messages promulgated by the American and European guidelines contributed to fuel confusion regarding the relative priority of the surgical over medical therapy in IE. The European Society of Cardiology (ESC) guidelines individuates three level of urgency: emergency surgery, to be performed within 24 hours; urgent surgery, recommended within a few days; elective surgery to be performed after 1-2 weeks of antibiotic therapy. Urgent surgery is recommended for most cases of IE. In the American Heart Association (AHA)'s guidelines define early surgery as "during the initial hospitalization and before completion of a full course of antibiotics." Some of the available evidences showed that are no proven benefits in delaying surgery if a definite diagnosis of IE has been established. However, this argument is controversial across the literature and several factors including the center specific experience can play a role in decision-making. In this review the latest evidences on IE clinical and surgical characteristics along with the current studies on the adoption of an early surgical approach are analyzed to clarify whether enough evidence is available to inform an update of the guidelines.
Benedetto et al. (Tue,) conducted a review in Infective endocarditis. Early surgery vs. Conventional treatment was evaluated. Early surgery for infective endocarditis lacks robust randomized trial evidence compared to conventional treatment, with current guidelines relying primarily on expert opinion.