Outcomes of Cardiac Reoperations Due to Prosthetic Valve Infective Endocarditis (PVIE)

All articles of this category (opens in new window) Background: PVIE constitutes a serious complication following valve replacement. Surgical reintervention is considered the treatment of choice but remains associated with substantial mortality rates (20–40%). This study investigates clinical outcomes of surgically treated PVIE cases at our institution. Methods: We retrospectively evaluated 172 patients (mean age 66.3 ± 12.5 years (SD); 79.1% male) who underwent surgical reintervention for PVIE between 2011 and 2025. Assessed parameters included time to reintervention, patient-related risk factors, hospital stay, in-hospital mortality rate (MR) and severe adverse events (SAE; defined as: severe infection (bacteremia/sepsis, endocarditis, deep wound infection, mediastinitis), rethoracotomy, relevant arrhythmia, myocardial infarction, low cardiac output syndrome (LCOS), neurological complications, dialysis/hemofiltration, delirium (interrelations were considered); categorized into groups: I: 0 events, II: 1–2 events, III: 3–4 events, IV: >4 events). Statistical significance was assessed using chi-square tests and logistic regression. Results: A total of 157 aortic prosthesis replacements were performed (77.7% aortic root replacement). Mitral prosthesis replacements were conducted in 35 patients (12 isolated, 23 combined procedures). The median time between the initial intervention and reintervention was 1.57 years (IQR: 0.39–5.13). The overall MR was 24.4%, compared with 14.7% in nonendocarditis reinterventions at our institution. Survivors had a median hospital stay of 20 days (IQR: 13.25–34.75). SAE occurred in 161 patients (93.6%). MR increased with the number of SAE in the following groups: I: 0% ( n = 11), II: 17.3% ( n = 81), III: 39.3% ( n = 56), IV: 25.0% ( n = 24). Preexisting central neurological impairments were associated with increased MR (OR=2.26; p = 0.031; n = 70). Aortic root replacement was associated with a higher mortality compared to isolated aortic prosthesis replacement (27.9% vs. 17.1%); this difference was not statistically significant. Conclusion: Reintervention in PVIE patients remains a high-risk procedure, with significantly elevated MR compared to nonendocarditis cases, consistent with existing literature. SAE occurred in most patients and correlated with MR. Only a small number of patients experienced a completely complication-free postoperative course. Preexisting neurological impairments were independently associated with increased MR. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany