{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:39:31Z","timestamp":1760060371280,"version":"build-2065373602"},"reference-count":25,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T00:00:00Z","timestamp":1755648000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: We compared short- and long-term outcomes of patients with native left-sided infective endocarditis (IE) confined to the valve leaflet (\u201csimple\u201d) versus those with perivalvular extension (\u201ccomplex\u201d) over two decades. Methods: From 2005 to 2024, 177 patients (mean age 59.6 \u00b1 13.8 years, 71.8% male) underwent surgery for IE. Patients were classified as having simple (n = 129) or complex IE (n = 48) based on imaging and intraoperative findings. Mean follow-up was 86.5 \u00b1 63.3 months (range: 2\u2013232 months). Outcomes included operative and late mortality, recurrent infection, and reoperation. Results: Complex IE was associated with worse preoperative status, longer ICU stays, and mechanical ventilation times. Predictors of early mortality included critical preoperative state (OR 6.35, p = 0.001), chronic renal failure\/dialysis (OR 3.01, p = 0.05), and staphylococcal IE (OR 5.62, p = 0.002) but not perivalvular extension. Overall survival at 1, 5, 10, 15, and 20 years was 83%, 74.2%, 59.9%, 51.3%, and 40.7%, with no significant difference between groups (p = 0.18). Female gender (HR 1.93, p = 0.04) and chronic renal failure (HR 3.5, p &lt; 0.01) predicted late mortality. Freedom from re-endocarditis and reoperation d\/t relapse of endocarditis was 94.2% and 97.3%, respectively. Freedom from re-intervention d\/t structural valve degeneration was 92.1% at 10 years. Repair was performed in 28.2% of cases involving the mitral valve, with 93.1% freedom from reoperation. Conclusions: Surgery for complex IE is not an independent risk factor for long-term mortality. Rates of recurrent endocarditis and reoperation are remarkably low. Excellent durability of bioprostheses and mitral repair was demonstrated.<\/jats:p>","DOI":"10.3390\/jcm14165870","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T15:53:37Z","timestamp":1755705217000},"page":"5870","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgery for Complex vs. Simple Native Left-Sided Endocarditis: Insights from an Extended Follow-Up on Survival, Recurrent Infection, and Valve Durability"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5771-1688","authenticated-orcid":false,"given":"Reut","family":"Shavit","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa 3436212, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2523-6469","authenticated-orcid":false,"given":"Katia","family":"Orvin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hila","family":"Shaked","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Rabin Medical Center, Petah Tikva 4941492, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor","family":"Rubchevsky","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8464-6006","authenticated-orcid":false,"given":"Yaron","family":"Shapira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7708-8253","authenticated-orcid":false,"given":"Ran","family":"Kornowski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rabin Medical Center, Petah Tikva 4941492, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9897-154X","authenticated-orcid":false,"given":"Ram","family":"Sharony","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6997801, Israel"},{"name":"Department of Cardiothoracic Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S0140-6736(24)01098-5","article-title":"Infective endocarditis","volume":"404","author":"Li","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC Guidelines for the management of endocarditis","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur. 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Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5870\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:31:34Z","timestamp":1760034694000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/16\/5870"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,20]]},"references-count":25,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14165870"],"URL":"https:\/\/doi.org\/10.3390\/jcm14165870","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,8,20]]}}}