A vegetation size of ≥10 mm in left-sided infective endocarditis is a strong predictor of embolic events and increased mortality, serving as an indication for surgical intervention.
Systematic Review
Is vegetation size ≥10 mm an indication for surgery to prevent embolic events and mortality in patients with infective endocarditis?
There is strong evidence that a vegetation size of ≥10 mm, especially in left-sided infective endocarditis, is an indication for surgery to prevent embolic events and mortality.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the of vegetations in endocarditis is an indication for surgery. Altogether, 102 papers were found using the reported search; 16 papers were identified that provided the best evidence to answer the question. The authors, journal, date, country of publication, patient group, study type, relevant outcomes and results were tabulated. The vegetation size was classified into small (10 mm and severe vegetation mobility were predictors of new embolic events. Equally, a meta-analysis showed that the echocardiographic detection of a vegetation size of ≥10 mm in patients with left-sided infective endocarditis posed significantly increased risk of embolic events. In another prospective cohort study of 211 patients, it was observed that there was an increased risk of embolization with vegetations of ≥10 mm. In similarly another study of 178 consecutive patients with infective endodarditis assessed by echocardiographic study, it was found out that there was a significantly higher incidence of embolism with a vegetation size >10 mm (60%, P1.8 cm2 predicted the development of a complication. Assuming that the vegetation was a sphere, the calculated diameter will be 8 mm when using 4Ωr2 for the area. However, for right-sided infection endocarditis, a vegetation size of >20 mm was associated with a higher mortality when compared with a vegetation size of ≤20 mm. There is strong evidence to suggest that a vegetation size of ≥10 mm especially for left-sided infective endocarditis is an indication for surgery.
Okonta et al. (2012) conducted a systematic review in Infective endocarditis. Vegetation size ≥10 mm (left-sided) or >20 mm (right-sided) vs. Smaller vegetation sizes was evaluated on Embolic events and mortality. A vegetation size of ≥10 mm in left-sided infective endocarditis is a strong predictor of embolic events and increased mortality, serving as an indication for surgical intervention.