{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:46:31Z","timestamp":1792125991956,"version":"4.4.0"},"reference-count":89,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":91,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infective endocarditis (IE) carries in-hospital mortality of 15\u201320% and 1-year mortality approaching 40%, with surgery required in 40\u201350% of cases. IE is not uniformly distributed across cardiac valves aortic 30\u201345%, mitral 25\u201330%, tricuspid 5\u201310%, pulmonary\u2009&lt;\u20092%, PVE 10\u201330% and this distribution reflects valve-specific anatomical determinants governing surgical complexity and outcomes. Despite the 2023 ESC Guidelines, a unified structural framework linking anatomical vulnerability to surgical decision-making remains absent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To propose a valve-specific structural vulnerability framework and examine its implications for surgical complexity, perioperative outcomes, and re-surgery risk across all cardiac valve types.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative review of peer-reviewed literature (2015\u20132025) was conducted across PubMed, Scopus, and MEDLINE. Systematic reviews, meta-analyses, multicentre registries, and guideline documents were synthesised narratively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Findings<\/jats:title>\n                    <jats:p>A structural vulnerability gradient (prosthetic valves\u2009&gt;\u2009aortic\u2009&gt;\u2009mitral\u2009&gt;\u2009tricuspid\u2009&gt;\u2009pulmonary) is proposed as a conceptual model of valve-specific disease behaviour. Aortic IE carries maximal vulnerability through peri-annular extension, 30\u201340% of cases, requiring radical root reconstruction with elevated operative mortality. Mitral IE exhibits conditional vulnerability; repair yields superior outcomes over replacement. Tricuspid IE is predominantly IVDU-associated with comparatively lower operative mortality. PVE carries the highest operative risk, with prolonged operative times and significant reoperation rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>IE is best understood as a valve- and substrate-specific disease in which anatomical determinants drive surgical complexity and clinical prognosis. This proposed vulnerability hierarchy may enable preoperative risk stratification, inform valve-specific surgical planning, and provide a mechanistic framework for understanding differential outcomes across valve types. Prospective outcome registries and standardised complexity metrics are needed to validate and refine this conceptual model.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13019-026-04523-w","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:24:51Z","timestamp":1784309091000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Valve-specific structural vulnerability in infective endocarditis: a narrative review of surgical complexity and outcomes"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8526-5790","authenticated-orcid":false,"given":"Najmi Hakim","family":"Abd Rani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1686-8632","authenticated-orcid":false,"given":"Afifah","family":"Mohamed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4850-901X","authenticated-orcid":false,"given":"Zaleha","family":"Md Isa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3278-2196","authenticated-orcid":false,"given":"Suhaini","family":"Kadiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9599-2353","authenticated-orcid":false,"given":"Taty Anna","family":"Kamarudin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"issue":"44","key":"4523_CR1","doi-asserted-by":"publisher","first-page":"3075","DOI":"10.1093\/eurheartj\/ehv319","volume":"36","author":"G Habib","year":"2015","unstructured":"Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis. 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This is a narrative review of published literature and does not involve human participants, human data, or human tissue.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"800"}}