Aortic Prosthetic Valve Endocarditis: Analysis of The Society of Thoracic Surgeons Database

Abstract

Background: This study sought to characterize the current US experience of aortic prosthetic valve endocarditis (PVE) compared with native valve endocarditis (NVE). Methods: The Society of Thoracic Surgeons Database was queried for entries of active aortic infective endocarditis (IE). Two analyses were performed: (1) trends of surgical volume and operative mortality (2011-2019); and (2) descriptive and risk-adjusted comparisons between PVE and NVE (2014-2019) using multivariable logistic regression. Results: From 2011 to 2019, there was a yearly increase in the proportion of PVE (20.9% to 25.9%; P <.001) with a concurrent decrease in operative mortality (PVE, 22.5% to 10.4%; P <.001; NVE, 10.9% to 8.5%; P <.001). From 2014 to 2019, active aortic IE was identified in 9768 patients (NVE, 6842; PVE, 2926). Aortic root abscess (50.1% vs 25.2%; P <.001), aortic root replacement (50.1% vs 12.8%; P <.001), homograft implantation (27.2% vs 4.1%; P <.001), and operative mortality (12.2% vs 6.4%; P <.001) were higher in PVE. After risk adjustment, PVE (odds ratio [OR], 1.5; 95% CI,1.16-1.94; P <.01), aortic root replacement (OR, 1.49; 95% CI,1.15-1.92; P <.001), Staphylococcus aureus (OR, 1.5; 95% CI,1.23-1.82; P <.001), and unplanned revascularization (OR, 5.83; 95% CI,4.12-8.23; P <.001) or mitral valve surgery (OR, 2.29; 95% CI,1.5-3.51; P <.001) correlated with a higher operative mortality, whereas prosthesis type (P =.68) was not an independent predictor. Conclusions: IE in the United States has risen over the past decade. However, operative mortality has decreased for both PVE and NVE. PVE, extension of IE requiring aortic root replacement, and additional unplanned surgical interventions carry an elevated mortality risk. Prosthesis selection did not affect operative mortality.