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

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. 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). 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. 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. On en connaît peu sur le pronostic à moyen terme des patients non âgés (≤ 60 ans) après le traitement chirurgical de l’endocardite infectieuse (EI) isolée de la valve aortique. Une meilleure caractérisation de ces résultats pourrait aider à adapter la prise en charge chirurgicale à ces patients. De 2000 à 2015, 164 patients adultes ≤ 60 ans (moyenne de 46 ± 11 ans, 81 % d’hommes) ont subi un traitement chirurgical pour l’EI isolée de la valve aortique dans 2 établissements canadiens très fréquentés. Vingt-trois patients (14 %) étaient des utilisateurs de drogues par injection (UDI). Les patients ayant eu une EI récidivante ou une endocardite concomitante sur d’autres valves ont été exclus. La valve aortique a été remplacée par une prothèse mécanique (44 %), une valve tissulaire (