Outcomes of Bicuspid vs. Tricuspid Aortic Valve Endocarditis: Insights from a Propensity Score-Matched Analysis of the CAMPAIGN Study Group

All articles of this category (opens in new window) Background: Bicuspid aortic valve (BAV) occurs in less than 2% of the general population but is associated with an increased susceptibility to native valve infective endocarditis (IE) compared to the tricuspid aortic valve (TAV). This study aims to compare clinical outcomes following surgical aortic valve replacement (SAVR) in patients with IE involving BAV vs. TAV and to evaluate the independent impact of BAV morphology on outcomes. Methods: This retrospective, multicenter cohort study analyzed data from the Multicentric Project for Analysis of Infective Endocarditis in Germany (CAMPAIGN) registry, focusing on patients diagnosed with native aortic valve infective endocarditis who underwent surgical valve replacement between 2006 and 2018 at six German tertiary care centers. Patients were stratified into two cohorts according to aortic valve morphology. Propensity score matching was performed to balance baseline characteristics between groups. Cox proportional hazards models were subsequently employed to evaluate the independent association of BAV morphology with both early postoperative and long-term clinical outcomes. Results: 462 patients were eligible for analysis,14.3% ( n = 66) had BAV. Patients with BAV underwent surgery at a significantly younger age compared to those with TAV (median [IQR]: 47.5 [36.75–57.25] vs. 63 [52–71] years, p < 0.001). The proportion of female patients was lower in the BAV group (10.6% vs. 21.2%, p = 0.045). After matching, 59 patients were included in each group. Significantly longer cardiopulmonary bypass times in the BAV group (median [IQR]: 109 [93–136] vs. 88 [65.5–121] minutes, p = 0.034) and aortic cross-clamp times (77 [66–98] vs. 59 [43.5–83.5] minutes, p = 0.010) were observed. No statistically significant difference was observed in 30-day mortality between the groups (3.39% vs. 10.17%, p = 0.272). Similarly, long-term survival analysis showed no significant difference ( p = 0.069). Cox regression analysis did not identify bicuspid aortic valve (BAV) morphology as an independent predictor for reoperation (hazard ratio [HR] 0.36; 95% confidence interval [CI], 0.13–1.02; p = 0.083) or mortality (HR: 0.36; 95% CI: 0.13–1.02; p = 0.083). Conclusion: Patients with BAV presented with infective endocarditis requiring surgical intervention at a significantly younger age compared to patients with TAV. The longer aortic cross-clamp and cardiopulmonary bypass times observed in the BAV group suggest a potentially more complex surgical management. Despite these differences, both short-term and long-term outcomes were comparable between the two groups. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany