Early outcomes and predictors of mortality in native aortic valve endocarditis: results from a national registry

Background
Native aortic valve endocarditis continues to present significant operative challenges, often complicated by heart failure, peri-annular extension and conduction disturbances. This study aimed to evaluate temporal trends, outcomes and predictors of mortality following surgery within a nationwide cohort.

Methods
A retrospective analysis was performed using data from the UK National Institute for Cardiovascular Outcomes Research registry. All patients undergoing aortic valve replacement (AVR) for infective endocarditis between 1996 and 2019 were included. The primary endpoint was in-hospital mortality. Univariate and multivariable logistic regression analyses were conducted to identify independent predictors of adverse outcomes, with bootstrap validation across 500 datasets.

Results
A total of 3694 patients underwent AVR for native valve endocarditis between 1996 and 2019. Mean age was 58.0 years (IQR 45.9–68.2) and 21.9% (n=809) were female. Biological prostheses were most frequently implanted (55.7%). In-hospital mortality was 7.8% (n=290).

Non-survivors were significantly older and more likely to have chronic kidney disease, diabetes, pulmonary disease, cardiogenic shock and poor preoperative ventricular function. On multivariable analysis, operative urgency (OR 2.49, 95% CI 1.98 to 3.14) and preoperative inotropic support (OR 2.24, 95% CI 1.42 to 3.52) were the most powerful predictors of mortality. Other risk factors included New York Heart Association class III–IV (OR 1.73–1.94), advanced age (OR 1.02/year), chronic kidney disease (OR 1.53) and preoperative atrial fibrillation (OR 1.58). Later years of surgery conferred improved survival (OR 0.96, 95% CI 0.94 to 0.99).

Conclusions
Surgery for native aortic valve endocarditis remains high risk, though outcomes have improved over time. Operative urgency and preoperative inotropic requirement are the most powerful predictors of mortality.