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Twenty-Five Year Outcomes of Patients Undergoing Valve Surgery for Infective Endocarditis
Dinela Rushani1, Terrence Yau1, Douglas S Lee2
1Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
The Journal of Thoracic and Cardiovascular Surgery
|July 15, 2026
Summary
Long-term outcomes after valve surgery for infective endocarditis (IE) are worse for patients with active infection and abscesses. Factors like infection severity, comorbidities, and socioeconomic status impact long-term mortality post-IE surgery.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Clinical Outcomes Research
Background:
- Infective endocarditis (IE) poses significant risks, with limited long-term data post-valve surgery.
- Understanding long-term outcomes is crucial for managing this severe condition.
Purpose of the Study:
- To analyze 25-year outcomes following valve surgery for infective endocarditis.
- To compare outcomes based on the severity of infection: remote, active without abscess, and active with abscess.
Main Methods:
- Retrospective cohort study of 1,095 patients undergoing valve surgery for IE (1990-2014).
- Data linked from clinical and administrative sources with follow-up until March 2024 (median 14 years).
- Assessed survival and freedom from major adverse valve-related events (MAVRE) using Cox regression.
Main Results:
- Twenty-five-year survival rates were 39.5% (remote IE), 30.8% (active without abscess), and 26.0% (active with abscess).
- Freedom from MAVRE at 25 years was 22.1% (remote), 15.7% (active without abscess), and 12.6% (active with abscess).
- Predictors of late mortality included active infection with abscess, LV dysfunction, comorbidities, frailty, and lower income.
Conclusions:
- Active infective endocarditis with abscesses is associated with significantly worse long-term outcomes after valve surgery.
- Infection severity, comorbidities, cardiac function, and socioeconomic factors are key determinants of mortality post-IE surgery.
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