Reoperative surgery for early- and late-onset prosthetic valve endocarditis: temporal trends and outcomes

OBJECTIVES
Prosthetic valve endocarditis (PVE) remains a serious complication following aortic valve replacement, with varying outcomes based on timing of presentation. This study investigated the relationship between timing of reoperation and outcomes in PVE patients using a nationwide database, while examining temporal trends and identifying mortality risk factors.

METHODS
We analysed 406 patients who underwent reoperative surgery for PVE between 1996 and 2019 across the United Kingdom using the National Institute of Cardiovascular Outcomes Research database. Patients were categorized into early (≤1 year, n = 131) and late (>1 year, n = 275) reoperation groups. Propensity score matching was performed to compare outcomes, and multivariable analysis identified mortality predictors.

RESULTS
The overall incidence of reoperative surgery for PVE increased over the study period, while the proportion of early-onset PVE decreased from 85.7% in 1998 to 20% in 2019. In matched groups (113 pairs), early reoperation cases required longer cardiopulmonary bypass (135 vs 122 min, P = 0.005) and cross-clamp times (95 vs 88 min, P = 0.011), with extended hospital stays (18.5 vs 14.0 days, P = 0.006). Overall mortality was 8.4%, with an early mortality of 10.8% opposed to 6.2% in late cases (P = 0.338; Lasso AUC: 0.746). Age emerged as the strongest predictor of mortality (OR: 1.14, 95% CI: 1.05–1.27, P = 0.0).

CONCLUSIONS
This nationwide analysis demonstrates improved PVE outcomes compared to historical data, with overall mortality of 8.4%. While early reoperations were associated with more complex procedures and longer hospital stays, mortality rates were statistically similar. Age remains the primary determinant of mortality risk.