Key result
Prosthetic valve endocarditis links to ~76% higher 30-day mortality than native endocarditis, but similar 10-year survival for survivors.
Why the study?
Most patients with prosthetic valve endocarditis require cardiac surgery, yet data on outcomes following surgery are scarce.
Does aortic valve surgery for prosthetic valve endocarditis result in similar long-term survival compared to native valve endocarditis in patients who survive past 30 days?
Cohort (n=2,585)
Yes
Does aortic valve surgery for prosthetic valve endocarditis result in similar long-term survival compared to native valve endocarditis in patients who survive past 30 days?
Patients undergoing aortic valve surgery for prosthetic valve endocarditis who survive the first 30 days have a similar 10-year prognosis to those with native valve endocarditis.
Higher early mortality after PVE surgery warrants perioperative caution; leaves open whether long-term survival matches NVE in broader cohorts.
Background An increasing number of people live with aortic prosthetic valves. Over time, up to 10% of them may develop prosthetic valve endocarditis (PVE)—a serious and life-threatening complication. Cardiac surgery is needed in the majority of patients with PVE, yet data on outcomes after surgery are scarce. The aim of the study is to examine outcomes after aortic valve surgery for PVE. Methods We conducted a population-based observational cohort study using data from SWEDEHEART and other national health registries. All patients receiving aortic valve surgery for endocarditis in Sweden (1997–2022) were included. The Kaplan-Meier method and regression standardisation were used to compare long-term survival among patients who lived past 30 days after surgery, comparing PVE and native valve endocarditis (NVE). Results Among 2585 patients, 685 (26%) had PVE and 1900 (74%) had NVE. PVE patients were older (68 years vs 61 years) and had more comorbidities than NVE patients. Mean follow-up was 7.1 years (maximum 26 years). 30-day mortality was higher among PVE (12%) than NVE (6.1%) patients; adjusted OR 1.76 (95% CI 1.20 to 2.59). Long-term survival was similar for PVE and NVE among patients who lived past 30 days after surgery; absolute survival difference at 10 years was −4.6% (95% CI −10.4 to 1.5). Conclusions While PVE patients had higher short-term mortality, patients who survived 30 days after surgery had a similar 10-year prognosis to NVE patients. These results are encouraging and suggest that good long-term outcomes are achievable after surgery for PVE.
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Bearpark et al. (2026) conducted a cohort in Prosthetic valve endocarditis (n=2,585). Prosthetic valve endocarditis vs. Native valve endocarditis was evaluated on 30-day mortality (adjusted OR 1.76, 95% CI 1.20 to 2.59). Prosthetic valve endocarditis had higher 30-day mortality than native valve endocarditis (12% vs 6.1%; OR 1.76, 95% CI 1.20-2.59), but similar 10-year survival among 30-day survivors.
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