Early and late outcomes after aortic valve replacement, mitral valve replacement and mitral valve plasty for native and prosthetic valve endocarditis in the Netherlands

Objectives The aim of this nationwide descriptive study is to assess short-, mid-, and long-term mortality risk following aortic valve replacement (AVR), mitral valve replacement (MVR) and mitral valve plasty (MVP) in patients with native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Mortality outcomes were also evaluated for biological and mechanical valve prostheses. Methods Patients with infective endocarditis who underwent AVR, MVR or MVP between 2013 and 2022 were included from the Netherlands Heart Registration. Patients were excluded in case of combined valve surgery, aortic root replacement, a history of non-valvular cardiac surgery followed by NVE and unclear surgical history precluding confirmation of PVE. Descriptive analyses were performed, and mortality risks were estimated using Kaplan–Meier analysis. Results 1810 patients were included, of whom 75.4% had NVE and 24.6% PVE. In NVE, short-term mortality was highest after MVR (13.2%), followed by AVR (4.6%) and MVP (3.8%). Long-term mortality risks were 32.1%, 22.3%, and 11.5%, respectively. In PVE, short-term mortality risk was highest in AVR (10.2%), followed by MVR (7.6%) and MVP (5.0%). Long-term mortality risks were 27.3%, 31.7% and 35.2%, respectively. Short-term mortality was similar between patients receiving biological and mechanical prosthesis in the AVR and MVR groups, whereas long-term mortality was higher among those who received biological prostheses. Conclusions This nationwide study shows that mortality after cardiac surgery for infective endocarditis considerably varies by valve and prosthesis type. In NVE, mortality was highest after MVR. In PVE, outcomes were comparable across procedures. Long-term mortality was lowest with mechanical prostheses.