Surgery for native aortic valve infective endocarditis (IE) remained high risk, with in-hospital mortality of 7.8% in a nationwide UK registry study of 3694 patients undergoing aortic valve replacement (AVR) between 1996 and 2019. The analysis, published in the Open Heart, used data from the UK National Institute for Cardiovascular Outcomes Research registry.

All patients undergoing AVR for native aortic valve IE were included. The primary endpoint was in-hospital mortality. Associations between baseline clinical factors and outcomes were assessed using univariate and multivariable logistic regression, with bootstrap validation across 500 datasets.

The mean age was 58.0 years (interquartile range 45.9–68.2), and 21.9% were female. Biological prostheses were implanted in 55.7% of cases. Overall, in-hospital mortality was 7.8% (n=290). Patients who died in hospital were older and more likely to have chronic kidney disease (CKD), diabetes, pulmonary disease, cardiogenic shock, and impaired preoperative ventricular function.

On multivariable analysis, operative urgency (odds ratio [OR] 2.49; 95% confidence interval [CI] 1.98-3.14) and preoperative inotropic support (OR 2.24; 95% CI 1.42-3.52) were the strongest predictors of mortality. Additional risk factors included New York Heart Association (NYHA) class III–IV (OR 1.73-1.94), increasing age (OR 1.02 per year), CKD (OR 1.53), and preoperative atrial fibrillation (AF) (OR 1.58). Later surgical years were associated with improved survival (OR 0.96; 95% CI 0.94-0.99).

The findings suggest surgery for native aortic valve IE remains associated with substantial in-hospital risk, although outcomes improved over time. Operative urgency and preoperative inotropic support were strongly associated with mortality.