Prosthetic valve endocarditis: valve type, microbiological patterns, and mortality-a nationwide multicenter cohort study

Prosthetic valve endocarditis (PVE) carries high mortality. The impact of prosthetic valve type on outcomes remains unclear, particularly with the increasing use of transcatheter valves. We aimed to identify predictors of 30-day and 1-year mortality in PVE and assess the association between valve type and outcomes.

In this retrospective multicenter cohort study, patients aged ≥ 18 years with definite or possible PVE from the Türkiye Endocarditis Group registry between January 2016 and December 2025 were included. Valve type was evaluated across three groups: mechanical PVE (mPVE), surgical bioprosthetic PVE (bPVE), and percutaneous bPVE. Cox proportional hazards models were used.

A total of 261 patients were included (median age 63 years [IQR 49-71], 37.9% female). Among patients with available follow-up data, the 30-day and 1-year mortality rates were 23.1% (58/251) and 46.3% (100/216), respectively. In multivariable analysis, age (HR 1.027 per year; 95% CI 1.006-1.049), creatinine level on admission (HR 1.154 per mg/dL; 95% CI 1.019-1.306), and cardiac complications (HR 3.589; 95% CI 2.080-6.193) were independently associated with 30-day mortality and remained significant for 1-year mortality. Valve type was not independently associated with mortality after adjustment for measured confounders. Enterococcus spp. were more frequent in percutaneous bPVE.

In this national multicenter cohort, PVE carried high mortality regardless of valve type. Older age, higher creatinine levels, and cardiac complications-but not valve type-were the strongest predictors of short- and long-term mortality. The higher frequency of Enterococcus spp. in percutaneous bPVE suggests that valve type may be more closely related to microbiological profile than prognosis.