Mid-term Outcomes in Nonelderly Adults Undergoing Surgery for Isolated Aortic Valve Infective Endocarditis: Results From Two Canadian Centers

Background: Little is known about the mid-term prognosis of nonelderly patients (≤60 years) after the surgical treatment of isolated aortic valve infective endocarditis (IE). Better characterization of these outcomes could help in tailoring the surgical management in these patients. Methods: From 2000 to 2015, 164 adult patients ≤60 years of age (mean 46 ± 11 years, 81% male) underwent surgical treatment for isolated aortic valve IE in 2 high-volume Canadian centers. Twenty-three patients (14%) were intravenous drug users (IVDUs). Patients with recurrent IE or concomitant endocarditis on other valves were excluded. The aortic valve was replaced with a mechanical prosthesis (44%), a tissue valve (30%), a homograft (18%), or a Ross procedure (9%). Mean follow-up was 6.2 ± 4.6 years (92% complete). Results: Thirty-day mortality was 7%. Actuarial survival rates at 5 and 10 years were 80 ± 3% and 71 ± 4%, respectively. IVDU (hazard ratio [HR] 3.8, 95% CI 1.4-10.1; P = 0.01) and prosthetic valve endocarditis (HR 2.6, 95% CI 1.1-6.4; P = 0.04) were associated with increased mid-term mortality. Mid-term survival was best in non-IVDU patients with native valve endocarditis, yet lower than a matched elective aortic valve replacement (AVR) population. Overall, freedom from recurrence of IE at 1, 5, and 10 years was 94 ± 2%, 91 ± 3%, and 89 ± 3%, respectively. IVDU was associated with higher rates of recurrence, especially in the first year after surgery. Conclusions: In nonelderly adults undergoing surgery for aortic valve IE, mid-term survival is suboptimal. Although non-IVDU patients with native valve endocarditis have better mid-term outcomes, survival remains lower than a matched population of elective AVR in nonelderly patients.