Key result
Surgery provided no survival benefit over medical management in patients with left-sided prosthetic valve endocarditis who had only non-classical surgical indications (10% vs. 17%; p=0.999).
Why the study?
Evidence supporting surgery for non-classical indications in prosthetic valve endocarditis remains limited, prompting an updated assessment of its clinical profile and the prognostic impact of surgery.
Does surgery improve survival in patients with left-sided prosthetic valve endocarditis, particularly those with non-classical surgical indications?
Cohort (n=589)
Yes
Does surgery improve survival in patients with left-sided prosthetic valve endocarditis, particularly those with non-classical surgical indications?
Absolute Event Rate: 10% vs 17%
p-value: p=0.999
Surgery improves survival in patients with classical indications for left-sided prosthetic valve endocarditis, but not for those with only non-classical indications, highlighting the need for individualized decision-making.
Background/Objectives: Prosthetic valve endocarditis (PVE) carries a high morbidity and mortality. Surgery is classically indicated for heart failure, uncontrolled infection, or prevention of embolic events; however, evidence supporting surgery for “non-classical” indications—such as Staphylococcus aureus infection, non-HACEK Gram-negative bacteria, or early PVE—remains limited. This study aimed to update the clinical and prognostic profile of PVE and assess the impact of surgery, particularly in patients with non-classical surgical indications. Methods: We prospectively included all definite left-sided PVE cases diagnosed between 2000 and 2024 at three tertiary centers. Clinical, microbiological, echocardiographic, and prognostic data were analyzed and compared. Predictors of in-hospital mortality were identified using multivariable logistic regression, and Kaplan–Meier curves were used to compare 1-year survival according to surgical indications. Results: Among 589 patients with left-sided PVE, 61% underwent surgery, and in-hospital mortality was 31%. Independent mortality predictors were chronic obstructive pulmonary disease, pulmonary hypertension, periannular complications, S. aureus infection, and poor clinical condition at admission. Non-classical surgical indications were present in 38% of patients, although only 28 (5%) of them had no other surgical indication. These patients exhibited lower mortality (14%) and no survival benefit from surgery (10% vs. 17%; p 0.999). Conclusions: PVE remains associated with high mortality. Surgery improves survival in patients with classical surgical indications but not in patients with non-classical indications, supporting individualized surgical decisions by a multidisciplinary endocarditis team.
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Ibáñez et al. (2026) conducted a cohort in Left-sided prosthetic valve endocarditis (n=589). Surgery vs. No surgery was evaluated on Mortality in patients with isolated non-classical surgical indications (p=0.999). Surgery provided no survival benefit over medical management in patients with left-sided prosthetic valve endocarditis who had only non-classical surgical indications (10% vs. 17%; p=0.999).
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