Abstract
BACKGROUND: Prosthetic valve endocarditis (PVE) is a serious complication of valve replacement associated with significant morbidity and mortality. However, outcomes for medical vs 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 at a tertiary-care centre 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. The in-hospital mortality incidence was 7.7% in the medical cohort and 10.7% in the surgical cohort, and the incidence of 90-day mortality was 30.8% and 21.4%, respectively. Surgical patients had a 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 favourable 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.