Native versus Prosthetic Valve Endocarditis: Predictors of Short- and Long-Term Outcome

Objectives: Cardiac surgery for prosthetic valve endocarditis (PVE) is associated with substantial short- and long-term mortality. We sought to evaluate short- and long-term outcome of patients undergoing surgery for PVE compared to native valve endocarditis (NVE) and aimed to identify pre- and intraoperative predictors for mortality.

Methods: We retrospectively analyzed the clinical data of all consecutive 418 patients undergoing valve surgery for infective endocarditis (IE) at our institution between January 2009 and July 2018. IE was defined according to the recent modified Duke Criteria and surgery indicated in compliance to current ESC guidelines. Postoperative outcomes of patients undergoing surgery for PVE and NVE were recorded. Univariate and multivariable analysis were performed to identify potential risk factors for short- and long-term mortality.

Results: Cardiac surgery was performed in 103 (24.6%) patients with PVE and 315 (75.4%) with NVE, respectively. PVE was associated with more severe manifestations reflected in a higher logistic EuroSCORE (PVE: 22.3% [9.8–36.2] vs. NVE: 10.2% [4.5–22.4], p < 0.001), impaired renal function (preoperative creatinine PVE: 1.43 mg/dL [1.0–2.35] vs. NVE: 1.16 mg/dL [0.86–1.67], p = 0.006) and more paravalvular abscess (PVE: 60.2% vs. NVE: 27%, p < 0.001). Involvement of the aortic valve was more common in PVE (52.4%) compared to NVE patients (37.5%; p = 0.007). Concerning postoperative outcomes, PVE was associated with a significantly higher in-hospital mortality (PVE 21.4 vs. NVE 8.3%, p < 0.001). In addition, patients with PVE had worse clinical courses with higher reexploration rates (PVE 25.5% vs. NVE 14.3%, p = 0.009), tracheostomy rates (PVE 19.4% vs. NVE 7.3%, p < 0.001) and a higher incidence of postoperative acute kidney injury (PVE 45.6% vs. NVE 34.1%, p = 0.035). However, long-term outcome during follow-up (up to 6 years) was comparable between both groups.

Conclusions: PVE is associated with more severe manifestations and extensive anatomic lesions, which contribute to an increased in-hospital mortality. Interestingly, long-term survival did not differ between patients undergoing surgery for PVE compared with NVE.