Surgery for Complex vs. Simple Native Left-Sided Endocarditis: Insights from an Extended Follow-Up on Survival, Recurrent Infection, and Valve Durability.

Background/

Objectives

We compared short- and long-term outcomes of patients with native left-sided infective endocarditis (IE) confined to the valve leaflet ("simple") versus those with perivalvular extension ("complex") over two decades.

Methods

From 2005 to 2024, 177 patients (mean age 59.6 ± 13.8 years, 71.8% male) underwent surgery for IE. Patients were classified as having simple (n = 129) or complex IE (n = 48) based on imaging and intraoperative findings. Mean follow-up was 86.5 ± 63.3 months (range: 2-232 months). Outcomes included operative and late mortality, recurrent infection, and reoperation.

Results

Complex IE was associated with worse preoperative status, longer ICU stays, and mechanical ventilation times. Predictors of early mortality included critical preoperative state (OR 6.35, p = 0.001), chronic renal failure/dialysis (OR 3.01, p = 0.05), and staphylococcal IE (OR 5.62, p = 0.002) but not perivalvular extension. Overall survival at 1, 5, 10, 15, and 20 years was 83%, 74.2%, 59.9%, 51.3%, and 40.7%, with no significant difference between groups (p = 0.18). Female gender (HR 1.93, p = 0.04) and chronic renal failure (HR 3.5, p < 0.01) predicted late mortality. Freedom from re-endocarditis and reoperation d/t relapse of endocarditis was 94.2% and 97.3%, respectively. Freedom from re-intervention d/t structural valve degeneration was 92.1% at 10 years. Repair was performed in 28.2% of cases involving the mitral valve, with 93.1% freedom from reoperation.

Conclusions

Surgery for complex IE is not an independent risk factor for long-term mortality. Rates of recurrent endocarditis and reoperation are remarkably low. Excellent durability of bioprostheses and mitral repair was demonstrated.