TOPLINE:

In patients with native aortic valve endocarditis, in‑hospital mortality after surgery was most strongly associated with operative urgency and the need for preoperative inotropic support.

METHODOLOGY:

• Researchers conducted a retrospective study to evaluate surgical outcomes and predictors of mortality in patients with native aortic valve endocarditis.
• Using data from the national UK cardiovascular registry, they identified 3694 patients (median age, 58.0 years; 21.9% women) who underwent aortic valve replacement for infective endocarditis between 1996 and 2019.
• Participants were categorised as survivors and non-survivors.
• Early mortality was defined as in-hospital mortality, that is, death occurring before hospital discharge following surgery for native aortic valve endocarditis.

TAKEAWAY:

• Overall, 7.85% of mortality was observed after surgery for native aortic valve endocarditis, with outcomes improving steadily over the study period; biological valves were the most frequently used prosthesis (55.7%), followed by mechanical valves (41.3%).
• Operative urgency and the need for preoperative inotropic support were the strongest predictors of in-hospital mortality (odds ratio [OR], 2.49 and 2.24, respectively; P < .001 for both).
• Additional independent predictors included older age (OR, 1.02 per year), advanced heart failure according to New York Heart Association functional class III (OR, 1.73) and class IV (OR, 1.94), chronic kidney disease (OR, 1.53), and preoperative atrial fibrillation (OR, 1.58; P < .05 for all).
• Odds of in‑hospital mortality increased modestly with longer cardiopulmonary bypass time; however, the more recent year of surgery was associated with lower odds of death (P < .01 for both).

IN PRACTICE:

"Operative urgency and the need for preoperative inotropic support emerged as the strongest predictors of mortality, which highlights the importance of surgical intervention before haemodynamic deterioration," the researchers of the study wrote.

"Although biological prostheses were most frequently employed, prosthesis choice should primarily be guided by conventional patient-specific factors rather than by endocarditis itself," they added.

SOURCE:

This study was led by Pradeep Narayan, Bristol Heart Institute, University of Bristol, Bristol, England. It was published online on April 21, 2026, in Open Heart.

LIMITATIONS:

The retrospective registry design limited the capture of key endocarditis‑specific clinical details. Decisions regarding surgical timing, perioperative support, and valve choice were made non‑randomly on the basis of clinician judgement and centre/surgeon preferences. Additionally, the study did not evaluate long‑term outcomes, such as late mortality, reinfection, reoperation, and structural valve deterioration.

DISCLOSURES:

This study received funding from the British Heart Foundation and the National Institute for Health and Care Research Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.