Does Perivalvular Involvement Affect the Long-Term Surgical Outcomes of Primary Left-Sided Endocarditis?

Surgical treatment of infective endocarditis (IE) remains challenging, especially in cases of perivalvular destruction and poor clinical presentation. We evaluated the outcomes of surgery for simple (isolated leaflet involvement) versus complex (perivalvular involvement) primary left-sided native valve endocarditis. From 2005 to 2019, a total of 128 consecutive patients (age 57.7 ± 14.2 years) with IE were surgically managed. Study end points were operative and late mortality and freedom from recurrent infection and reoperation for recurrent endocarditis. Patients were categorized as having simple IE (n = 91) versus complex IE (n = 37) based on the preoperative imaging and/or intraoperative findings. Valves involved were aortic in 39% (n = 50), mitral in 46% (n = 59), or both (11%, n = 14). The operative mortality was 11.7% (n = 15), and 9 of them (60%) presented with shock or multiorgan failure. A critical preoperative state was the only independent risk factor for early mortality (odds ratio 7.43, p