Outcomes of Tissue versus Mechanical Valve Replacement for Infective Endocarditis


  • Komkrit Komuttarin Cardiothoracic Unit, Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima
  • Nisit Poolthananant Cardiothoracic Unit, Department of Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima


Infective endocarditis, Prosthetic valve, Tissue valve, Mechanical valve


Objective: There is no consensus regarding the best prosthetic valve for patients with infective endocarditis (IE). The aim of the present study was to compare short and long-term outcomes of tissue versus mechanical valve replacement in patients with left-sided severe IE.

Methods: A retrospective medical chart review of IE patients treated between January 1st, 2008 and September 30th, 2020 was performed. Patients were categorized into two groups according to the type of prosthetic valve used (tissue or mechanical). Outcomes included in-hospital mortality, recurrent infection, reoperation and long-term survival.

Results: There were 147 patients. The overall in-hospital mortality was 17%. The in-hospital mortality rate was 27% and 14% for patients undergoing tissue and mechanical valve replacement, respectively. The recurrent infection rate was 3% and reoperation rate was 1%. The 5-year survival for patients in the tissue valve group was 71.4% (95% CI: 53.4% to 83.5%) and for the mechanical valve group, 81.5% (95% CI: 72.4% to 87.8%).

Conclusion: Mechanical prosthetic valve replacement in left-sided active endocarditis had better in-hospital mortality and long-term survival than tissue valve replacement, although the preoperative status of patients in the tissue valve group was worse. However, the recurrence rate was low and long-term survival was good for both groups.


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Angsutararux T, Angkasekwinai N. Cumulative incidence and mortality of infective endocarditis in Siriraj hospital, Thailand: a 10-year retrospective study. BMC Infect Dis 2019;19:1062. https://doi.org/10.1186/s12879-019-4689-5.

Pachirat O, Chetchotisakd P, Klungboonkrong V. Infective endocarditis: prevalence, characteristics and mortality in Khon Kaen, 1990-1999. J Med Assoc Thai 2002;85:1-10.

Pettersson GB, Hussain ST. Current AATS guidelines on surgical treatment of infective endocarditis. Ann Cardiothorac Surg 2019;8:630–44.

Delahaye F, Célard M, Roth O, et al. Indications and optimal timing for surgery in infective endocarditis. Heart 2004;90:618–20.

Bauernschmitt R, Jakob HG, Vahl CF, et al. Operation for infective endocarditis: results after implantation of mechanical valves. Ann Thorac Surg 1998;65:359–64.

Delahaye F, Antchouey A-M, Gevigney G de. Optimal timing for cardiac surgery in infective endocarditis: is earlier better? Curr Infect Dis Rep 2014;16:1–6.

Rostagno C, Carone E, Rossi A, et al. Surgical treatment in active infective endocarditis: results of a four-year experience. ISRN Cardiol 2011;2011:492543. doi:10.5402/2011/492543.

Mistiaen WP. What are the main predictors of in-hospital mortality in patients with infective endocarditis: a review. Scand Cardiovasc J 2018;52:58–68.

Hanai M, Hashimoto K, Mashiko K, et al. Active infective endocarditis. Circ J 2008;72:2062–8.

Mullany CJ, Chua YL, Schaff HV, et al. Early and late survival after surgical treatment of culture-positive active endocarditis. Mayo Clin Proc 1995;70:517–25.

Fayad G, Leroy G, Devos P, et al. Characteristics and prognosis of patients requiring valve surgery during active infective endocarditis. J Heart Valve Dis 2011;20:223–8.

d’Udekem Y, David TE, Feindel CM, et al. Long-term results of surgery for active infective endocarditis. Eur J Cardiothorac Surg 1997;11:46–52.

Spiliopoulos K, Giamouzis G, Haschemi A, et al. Surgical management of infective endocarditis: early and long-term mortality analysis. Single-center experience and brief literature review. Hellenic J Cardiol 2014;55:462–74.

Funakoshi S, Kaji S, Yamamuro A, et al. Impact of early surgery in the active phase on long-term outcomes in left-sided native valve infective endocarditis. J Thorac Cardiovasc Surg 2011;142:836-42.

Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015;36:3075-128.

Martin AK, Mohananey D, Ranka S, et al. The 2017 European Society of Cardiology (ESC)/European Association of Cardiothoracic Surgeons (EACTS) Guidelines for Management of Valvular Heart Disease-Highlights and Perioperative Implications. J Cardiothorac Vasc Anesth 2018;32:2810-6.

Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017;70:252-89.

Reul GJ, Sweeney MS. Bioprosthetic versus mechanical valve replacement in patients with infective endocarditis. J Card Surg 1989;4:348–51.

Moon MR, Miller DC, Moore KA, et al. Treatment of endocarditis with valve replacement: the question of tissue versus mechanical prosthesis. Ann Thorac Surg 2001;71:1164–71.

Gaca JG, Sheng S, Daneshmand MA, et al. Outcomes for endocarditis surgery in North America: a simplified risk scoring system. J Thorac Cardiovasc Surg 2011;141:98-106.

Musci M, Siniawski H, Pasic M, et al. Surgical therapy in patients with active infective endocarditis: seven-year single centre experience in a subgroup of 255 patients treated with the Shelhigh® stentless bioprosthesis. Eur J Cardiothorac Surg 2008;34:410–7.

Murashita T, Sugiki H, Kamikubo Y, et al. Surgical results for active endocarditis with prosthetic valve replacement: impact of culture-negative endocarditis on early and late outcomes. Eur J Cardiothorac Surg 2004;26:1104–11.

Mihaljevic T, Byrne JG, Cohn LH, et al. Long-term results of multivalve surgery for infective multivalve endocarditis. Eur J Cardiothorac Surg 2001;20:842–6.

Manne MB, Shrestha NK, Lytle BW, et al. Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Ann Thorac Surg 2012;93:489–93.

Aithoussa M, Atmani N, Mounir R, et al. Early results for active infective endocarditis. Pan Afr Med J 2017: https://www.panafrican-med-journal.com/content/article/28/245/full/

Moreillon P, Que Y-A. Infective endocarditis. Lancet 2004;363:139–49.

Nguyen DT, Delahaye F, Obadia JF, et al. Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses. Eur J Cardiothorac Surg 2010;37:1025–32.

Murdoch DR. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: The International Collaboration on Endocarditis–Prospective Cohort Study. Arch Intern Med 2009;169:463-73.

Hoen B, Duval X. Infective endocarditis. N Engl J Med 2013;368:1425–33.

Rostagno C, Rosso G, Puggelli F, et al. Active infective endocarditis: clinical characteristics and factors related to hospital mortality. Cardiol J 2010;17:566–73.

Bannay A, Hoen B, Duval X, et al. The impact of valve surgery on short- and long-term mortality in left-sided infective endocarditis: do differences in methodological approaches explain previous conflicting results? Eur Heart J 2011;32:2003–15.

Sandre RM, Shafran SD. Infective endocarditis: review of 135 cases over 9 years. Clin Infect Dis 1996;22:276–86.

Toyoda N, Itagaki S, Tannous H, et al. Bioprosthetic versus mechanical valve replacement for infective endocarditis: focus on recurrence rates. Ann Thorac Surg 2018;106:99–106.

Netzer ROM, Altwegg SC, Zollinger E, et al. Infective endocarditis: determinants of long term outcome. Heart 2002;88:61–6.

Meszaros K, Nujic S, Sodeck GH, et al. Long-term results after operations for active infective endocarditis in native and prosthetic valves. Ann Thorac Surg 2012;94:1024-10.

Leblebicioglu H, Yilmaz H, Tasova Y, et al. Characteristics and analysis of risk factors for mortality in infective endocarditis. Eur J Epidemiol 2006;21:25–31.

Hasbun R, Vikram HR, Barakat LA, et al. Complicated left-sided native valve endocarditis in adults: risk classification for mortality. JAMA 2003;289:1933-40.

Farag M, Borst T, Sabashnikov A, et al. Surgery for infective endocarditis: outcomes and predictors of mortality in 360 consecutive patients. Med Sci Monit 2017;23:3617–26.

Tugtekin SM, Alexiou K, Wilbring M, et al. Native infective endocarditis: which determinants of outcome remain after surgical treatment? Clin Res Cardiol 2006;95:72–9.

Mirabel M, Sonneville R, Hajage D, et al. Long-term outcomes and cardiac surgery in critically ill patients with infective endocarditis. Eur Heart J 2014;35:1195–204.

Thuny F, Giorgi R, Habachi R, et al. Excess mortality and morbidity in patients surviving infective endocarditis. Am Heart J 2012;164:94–101.

Delahaye F, Chu VH, Altclas J, et al. One-year outcome following biological or mechanical valve replacement for infective endocarditis. Int J Cardiol 2015;178:117–23.

Newton S, Hunter S. What type of valve replacement should be used in patients with endocarditis? Interact Cardiovasc Thorac Surg 2010;11:784–8.

Peterseim DS, Cen YY, Cheruvu S, et al. Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients. J Thorac Cardiovasc Surg 1999;117:890–7.

Delay D, Pellerin M, Carrier M, et al. Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis. Ann Thorac Surg 2000;70:1219–23.

Said SM, Abdelsattar ZM, Schaff HV, et al. Outcomes of surgery for infective endocarditis: a single-centre experience of 801 patients. Eur J Cardiothorac Surg 2018;53:435–9.

Flynn CD, Curran NP, Chan S, et al. Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis. Ann Cardiothorac Surg 2019;8:587–99.




How to Cite

Komuttarin K, Poolthananant N. Outcomes of Tissue versus Mechanical Valve Replacement for Infective Endocarditis. Thai J Surg [Internet]. 2022 May 5 [cited 2022 Aug. 13];43(1):26-34. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/251791



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