Surgery for Complex vs. Simple Native Left-Sided Endocarditis: Insights from an Extended Follow-Up on Survival,...

Area of Science:

• Cardiology
• Cardiac Surgery
• Infectious Diseases

Background:

• Native left-sided infective endocarditis (IE) presents challenges, with "simple" cases confined to valve leaflets and "complex" cases involving perivalvular extension.
• Understanding the long-term outcomes of surgical interventions for these distinct IE presentations is crucial for patient management.

Purpose of the Study:

• To compare the short- and long-term outcomes of surgical treatment for "simple" versus "complex" native left-sided infective endocarditis (IE).

Main Methods:

• A retrospective analysis of 177 patients who underwent surgery for IE between 2005 and 2024.
• Patients were categorized into "simple" (n=129) or "complex" (n=48) IE based on imaging and intraoperative findings.
• Outcomes assessed included operative mortality, late mortality, recurrent infection, and reoperation, with a mean follow-up of 86.5 months.

Main Results:

• Complex IE was associated with worse preoperative status and longer ICU stays, but perivalvular extension did not predict early mortality.
• Overall survival at 20 years was 40.7% with no significant difference between simple and complex IE groups (p=0.18).
• Female gender and chronic renal failure predicted late mortality; freedom from re-endocarditis and reoperation was high (94.2% and 97.3%).

Conclusions:

• Surgical treatment for complex infective endocarditis (IE) is not an independent risk factor for long-term mortality.
• Rates of recurrent endocarditis and reoperation following surgery for IE are remarkably low.
• Bioprosthetic valve durability and outcomes of mitral valve repair demonstrate excellent long-term performance.