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Outcomes of Prosthetic Valve Endocarditis Managed by a Multidisciplinary Endocarditis Team: A Retrospective Cohort Study

Year: 2025

Type: article

Abstract: Background Prosthetic valve endocarditis (PVE) is a serious complication of valve replacement associated with significant morbidity and mortality. However, outcomes between medical and surgical strategies remain incompletely characterized. Methods We conducted a retrospective cohort study of adult patients with PVE, defined by modified Duke Criteria, evaluated by a multidisciplinary endocarditis team (MDET) at a tertiary care center between September 2021 and February 2024. Demographic, clinical, management, and outcome data were collected. Logistic regression analyses were performed to identify factors associated with in-hospital mortality. Results Among 67 patients with PVE, 58.2% (n = 39) were managed medically and 41.8% (n = 28) underwent surgical intervention during the index hospitalization. Baseline characteristics and comorbidities were similar across groups. In-hospital mortality was 7.7% in the medical cohort and 10.7% in the surgical cohort, while 90-day mortality was 30.8% and 21.4%, respectively. Surgical patients had longer median length of stay (28 days vs. 15 days). Readmission and reinfection rates were comparable. Acute renal failure was the only independent predictor of in-hospital mortality on multivariable analysis (odds ratio, 9.61; 95% confidence interval, 1.19–77.67; p=0.04). Medical management was not independently associated with increased in-hospital mortality (odds ratio, 0.97; 95% confidence interval, 0.14–6.68; p=0.97). Conclusions In this cohort of patients with PVE, individualized treatment guided by a multidisciplinary team was associated with favorable short-term outcomes. Medical therapy may be a safe alternative in selected patients without surgical indications. Early identification of acute renal dysfunction may assist in prognostication and inform management decisions.

Source: CJC Open

DOI: 10.1016/j.cjco.2025.10.017