Abstract 11654: Surgical Versus Medical Therapy for Prosthetic Valve Endocarditis: A Systematic Review and Meta-Analysis of 32 Studies
Background: Prosthetic valve endocarditis (PVE) after valve replacement surgery is associated with significant morbidity and mortality. Whether a surgical or medical treatment strategy is preferable has not been clearly defined.
Methods: A systematic review was performed to identify studies that compared re-operative valve surgery versus medical therapy for PVE. A meta-analysis was conducted on the outcomes of 30-day mortality, and follow-up survival and recurrent PVE. Risk ratios (RR) and 95% confidence intervals (CI) were calculated utilizing the Mantel-Haenszel method under a fixed or random effects model, as appropriate. Continuous and categorical variables were compared utilizing an independent t-test and a chi-square or Fisher’s exact test, respectively.
Results: A total of 32 studies were identified, which included 2636 patients (Surgery=1320, Medical=1316), with a mean follow-up of 22 months (range 3-120). Patients undergoing valve reoperation were younger (58 ± 20 years versus 63 ± 22 years, p<0.0001), with a higher incidence of heart failure (38% versus 28%, p=0.0001) and paravalvular complications (paravalvular leak, prosthetic valve dehiscence, and/or paravavular abscess; 43% versus 19%, p<0.0001), while patients treated with medical therapy alone experienced more Staphylcoccus aureus PVE (32% versus 24%, p=0.0003). When compared with medical therapy, a valve reoperation was associated with a lower risk of 30-day mortality (25% versus 34%; RR 0.73, 95% CI 0.64-0.82, p<0.00001), and a greater survival at follow-up (69% versus 58%; RR 1.27, 95% CI 1.05-1.53, p=0.01), which was driven by the 15 studies published in the year 2000 or later. In patients with left-sided PVE, valve reoperation was also associated with a lower risk of 30-day mortality (25% versus 33%; RR 0.74, 95% CI 0.64-0.86, p<0.0001), and a greater survival at follow-up (71% versus 58%; RR 1.35, 95% CI 1.05-1.73, p=0.02), as compared with medical therapy. There was no difference in the incidence of recurrent PVE with regard to surgical versus medical therapy.
Conclusions: Compared with medical therapy, reoperative valve surgery results in lower 30-day mortality and a greater survival at follow-up, and may be preferable for patients with PVE.
Author Disclosures: C.G. Mihos: None. R. Capoulade: None. E. Yucel: None. M.H. Picard: None. O. Santana: None.
- © 2016 by American Heart Association, Inc.