Survival following aortic valve surgery for prosthetic valve endocarditis: a SWEDEHEART study

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.