Investigating the Impact of Disease Recurrence: Comparative Analysis of Surgical Outcomes for Recurrent versus Single Episode Infective Endocarditis

Abstract Infective endocarditis (IE) is a serious disease with a significant morbidity burden. Recurrence occurs in 8 to 10% of cases. Data on risk factors and outcomes in patients with recurrent IE are limited. This is a single-center observational analysis of consecutive patients, who underwent surgery for IE from 2009 to 2022. Patients with recurrent episodes of IE were identified and compared with patients after single episode IE regarding baseline characteristics and perioperative outcome. Risk factors for recurrence were identified by regression analysis. The total cohort comprised 665 patients. Of these, 10.2% (68/665) had recurrent IE. The median time to recurrence was 1.0 (1.55–3.49) years. Patients with recurrent IE were significantly younger with 58.1 ± 15.8 versus 62.6 ± 14.6 years (p < 0.017), but had a similar overall risk profile with EuroSCORE II 8.8 ± 3.9% versus 8.3 ± 3.7 (p = 0.271) compared with counterparts in the single episode group. Prosthetic valve IE (PVE) was more frequently noticed in the recurrence group at 45.6% (31/68) versus 20.5% (122/595; p < 0.001). Abscess formation with fistulas was documented more frequently in the recurrence group at 5.9% versus 1.8% (p = 0.034). Mortality rates at 30 days was lower in the recurrence group at 2.9% versus 14.7% (p = 0.007), while 1-year mortality was similar at 33.3% versus 32.9% (p = 0.948). Kaplan-Meier (KM) estimates revealed similar long-term survival in both groups (log rank p = 0.726). Previous valve implantation (due to a non-infectious reason) and history of IE (previously treated conservatively or surgically) were identified as independent predictors of recurrence with odds of 1.410 (1.030–1.931; p = 0.023) and 1.822 (1.164–2.628; p < 0.001), respectively. Recurrence of IE is associated with previous valve implantation and paravalvular complications like fistulas. Surgical treatment of such high-risk patients is feasible with good short-term survival and similar long-term outcomes compared with single episode IE patients.