{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T03:12:36Z","timestamp":1782875556440,"version":"3.54.5"},"reference-count":23,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"unspecified","delay-in-days":110,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Health Research Authority"},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012068","name":"Health and Care Research Wales","doi-asserted-by":"publisher","award":["257758"],"award-info":[{"award-number":["257758"]}],"id":[{"id":"10.13039\/100012068","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000883","name":"University of Bristol","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000883","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,3,17]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Native aortic valve endocarditis continues to present significant operative challenges, often complicated by heart failure, peri-annular extension and conduction disturbances. This study aimed to evaluate temporal trends, outcomes and predictors of mortality following surgery within a nationwide cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was performed using data from the UK National Institute for Cardiovascular Outcomes Research registry. All patients undergoing aortic valve replacement (AVR) for infective endocarditis between 1996 and 2019 were included. The primary endpoint was in-hospital mortality. Univariate and multivariable logistic regression analyses were conducted to identify independent predictors of adverse outcomes, with bootstrap validation across 500 datasets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3694 patients underwent AVR for native valve endocarditis between 1996 and 2019. Mean age was 58.0 years (IQR 45.9\u201368.2) and 21.9% (n=809) were female. Biological prostheses were most frequently implanted (55.7%). In-hospital mortality was 7.8% (n=290).<\/jats:p>\n                    <jats:p>Non-survivors were significantly older and more likely to have chronic kidney disease, diabetes, pulmonary disease, cardiogenic shock and poor preoperative ventricular function. On multivariable analysis, operative urgency (OR 2.49, 95%\u2009CI 1.98 to 3.14)\u2009and preoperative inotropic support (OR 2.24, 95%\u2009CI 1.42 to 3.52) were the most powerful predictors of mortality. Other risk factors included New York Heart Association class III\u2013IV (OR 1.73\u20131.94), advanced age (OR 1.02\/year), chronic kidney disease (OR 1.53) and preoperative atrial fibrillation (OR 1.58). Later years of surgery conferred improved survival (OR 0.96, 95%\u2009CI 0.94 to 0.99).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Surgery for native aortic valve endocarditis remains high risk, though outcomes have improved over time. Operative urgency and preoperative inotropic requirement are the most powerful predictors of mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-003997","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:25:16Z","timestamp":1776774316000},"page":"e003997","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Early outcomes and predictors of mortality in native aortic valve endocarditis: results from a national registry"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3843-1338","authenticated-orcid":false,"given":"Pradeep","family":"Narayan","sequence":"first","affiliation":[{"name":"Bristol Heart Institute, University of Bristol, Bristol, UK"},{"name":"Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1953-0063","authenticated-orcid":false,"given":"Tim","family":"Dong","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Chan","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6759-7719","authenticated-orcid":false,"given":"Daniel Paul","family":"Fudulu","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3009-5712","authenticated-orcid":false,"given":"Gianni D","family":"Angelini","sequence":"additional","affiliation":[{"name":"Bristol Heart Institute, University of Bristol, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"2026042105251207000_13.1.e003997.1","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1007\/s40121-023-00763-8","article-title":"Epidemiological Changes and Improvement in Outcomes of Infective Endocarditis in Europe in the Twenty-First Century: An International Collaboration on Endocarditis (ICE) Prospective Cohort Study (2000-2012)","volume":"12","author":"Ambrosioni","year":"2023","journal-title":"Infect Dis Ther"},{"key":"2026042105251207000_13.1.e003997.2","unstructured":"2023 ESC Guidelines for the management of endocarditis, Available: https:\/\/www.escardio.org\/Guidelines\/Clinical-Practice-Guidelines\/Endocarditis-Guidelines [Accessed 18 Oct 2025]."},{"key":"2026042105251207000_13.1.e003997.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2005.01289.x"},{"key":"2026042105251207000_13.1.e003997.4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz620"},{"key":"2026042105251207000_13.1.e003997.5","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2016-000545","article-title":"Risk and outcomes of aortic valve endocarditis among patients with bicuspid and tricuspid aortic valves","volume":"4","author":"Kiyota","year":"2017","journal-title":"Open Heart"},{"key":"2026042105251207000_13.1.e003997.6","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1016\/j.jtcvs.2020.08.117","article-title":"Utility and safety of coronary angiography in patients with acute infective endocarditis who required surgery","volume":"164","author":"Spanneut","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026042105251207000_13.1.e003997.7","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1016\/j.athoracsur.2021.10.045","article-title":"Aortic Prosthetic Valve Endocarditis: Analysis of The Society of Thoracic Surgeons Database","volume":"114","author":"Caceres Polo","year":"2022","journal-title":"Ann Thorac Surg"},{"key":"2026042105251207000_13.1.e003997.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-024-09782-3","article-title":"Clinical profile, microbiology and outcomes in infective endocarditis treated with aortic valve replacement: a multicentre case-control study","volume":"24","author":"Dingen","year":"2024","journal-title":"BMC Infect Dis"},{"key":"2026042105251207000_13.1.e003997.9","doi-asserted-by":"crossref","DOI":"10.1111\/eci.13476","article-title":"Surgical aortic valve replacement and infective endocarditis","volume":"51","author":"Malmberg","year":"2021","journal-title":"Eur J Clin Invest"},{"key":"2026042105251207000_13.1.e003997.10","doi-asserted-by":"crossref","DOI":"10.1093\/ejcts\/ezae031","article-title":"Impact of explanted valve type on aortic valve reoperations: nationwide UK experience","volume":"65","author":"Narayan","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026042105251207000_13.1.e003997.11","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.athoracsur.2022.12.045","article-title":"Risk Factors and Outcomes of Reoperative Surgical Aortic Valve Replacement in the United Kingdom","volume":"116","author":"Narayan","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"2026042105251207000_13.1.e003997.12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5090\/kjtcs.2020.53.1.1","article-title":"Surgical Outcomes for Native Valve Endocarditis","volume":"53","author":"Park","year":"2020","journal-title":"Korean J Thorac Cardiovasc Surg"},{"key":"2026042105251207000_13.1.e003997.13","doi-asserted-by":"crossref","first-page":"150","DOI":"10.4103\/JMISR.JMISR_47_20","article-title":"Predictors of mortality in valvular infective endocarditis: A single-center study","volume":"3","author":"Ali","year":"2020","journal-title":"J Med Sci Res"},{"key":"2026042105251207000_13.1.e003997.14","doi-asserted-by":"crossref","first-page":"504","DOI":"10.4070\/kcj.2020.0448","article-title":"Comparative Surgical Outcomes of Prosthetic and Native Valve Endocarditis","volume":"51","author":"Pyo","year":"2021","journal-title":"Korean Circ J"},{"key":"2026042105251207000_13.1.e003997.15","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1016\/j.athoracsur.2014.05.010","article-title":"Outcomes and prosthesis choice for active aortic valve infective endocarditis: analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database","volume":"98","author":"Savage","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2026042105251207000_13.1.e003997.16","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.athoracsur.2020.06.082","article-title":"Comparative Effectiveness of Mechanical Valves and Homografts in Complex Aortic Endocarditis","volume":"111","author":"Abdelsattar","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"2026042105251207000_13.1.e003997.17","doi-asserted-by":"crossref","first-page":"587","DOI":"10.21037\/acs.2019.10.03","article-title":"Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis","volume":"8","author":"Flynn","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"2026042105251207000_13.1.e003997.18","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1093\/icvts\/ivz122","article-title":"Mechanical versus biological valve prosthesis for surgical aortic valve replacement in patients with infective endocarditis","volume":"29","author":"Kyt\u00f6","year":"2019","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"2026042105251207000_13.1.e003997.19","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.027715","article-title":"Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta-Analysis","volume":"12","author":"Yokoyama","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"2026042105251207000_13.1.e003997.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2016.09.093"},{"key":"2026042105251207000_13.1.e003997.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00067-7"},{"key":"2026042105251207000_13.1.e003997.22","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.002365"},{"key":"2026042105251207000_13.1.e003997.23","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.amjcard.2015.11.012","article-title":"Usefulness of New-Onset Atrial Fibrillation, as a Strong Predictor of Heart Failure and Death in Patients With Native Left-Sided Infective Endocarditis","volume":"117","author":"Ferrera","year":"2016","journal-title":"Am J Cardiol"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-003997","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:25:22Z","timestamp":1776774322000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-003997"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,4,21]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/openhrt-2026-003997"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-003997","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}