Clinical Features and Outcomes of Surgically Treated Infective Endocarditis in Adults with and Without Congenital Heart Disease: A 12-Year Cohort Study

Background: Adults with congenital heart disease (CHD) are at markedly increased risk of infective endocarditis (IE); however, data comparing clinical characteristics and outcomes in surgically treated IE patients with and without CHD remain limited. This study aimed to evaluate differences in clinical profile, microbiology, complications, and outcomes between these groups. Methods: We conducted a retrospective cohort study of 773 adult patients who underwent surgery for IE at a tertiary center in China between October 2013 and August 2025. Patients were categorized into CHD (n = 188) and non-CHD (n = 585) groups. Baseline characteristics, microbiological findings, operative data, and postoperative outcomes were compared. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Long-term survival was assessed using Kaplan–Meier analysis. Results: Patients with CHD were significantly younger and had fewer cardiovascular comorbidities than non-CHD patients. CHD was associated with a higher prevalence of right-sided and multivalvular infection, whereas non-CHD patients predominantly had left-sided disease. Streptococcus species were the most common pathogens in both groups, with no significant intergroup differences in microbiological profiles. After IPTW adjustment, no significant differences were observed in major postoperative complications, length of stay, or early mortality. Overall and in left-sided IE, long-term survival was comparable between groups, whereas in right-sided IE, patients with CHD appeared to have more favorable long-term survival (HR = 0.17, 95% CI: 0.04–0.66, p = 0.01). Conclusions: Despite distinct clinical characteristics, adults with and without CHD undergoing surgery for IE had similar overall outcomes, although CHD was associated with better long-term survival in right-sided IE.