{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T10:41:47Z","timestamp":1792233707251,"version":"4.4.0"},"reference-count":25,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T00:00:00Z","timestamp":1765584000000},"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>Objectives: Infective endocarditis (IE) is a feared and life-threatening complication, requiring a multidisciplinary approach. Prosthetic valve endocarditis (PVE) accounts for 20\u201330% of IE, is one of the most severe forms of IE, and is associated with high morbidity and mortality. We aim to compare and analyze baseline characteristics, microbiology, clinical presentation, complications, and prognosis between biological and mechanical PVE; we also carried out a subgroup analysis of patients aged 45\u201365 at the time of onset of prosthetic surgery. Methods: The present study is a post hoc analysis of a prospective multicenter cohort of patients with PVE between January 2008 and December 2023. Patients were divided into two groups regarding the type of prosthesis, mechanical vs. biological. Results: A total of 1544 patients were included. 733 (47.47%) patients with mechanical PVE (mPVE) and 811 (52.52) with biological PVE (bPVE). We found that bPVE appeared earlier than mPVE, had more healthcare-related infections and paravalvular complications. Both groups had similar clinical presentations; moreover, there was no difference in surgical indication and if surgery was performed. On the other hand, mPVE has a higher incidence of Staphylococcus aureus (SA) and Gram-negative bacteria, while bPVE has more coagulase-negative staphylococci. Multivariable logistic regression identified the following independent risk factors of mortality: EuroSCORE I, age, mPVE, SA, IE comprising two valves, and severe sepsis. mPVE had a higher mortality on admission, probably due to a higher incidence of septic shock and CNS embolism. The subgroup analysis of patients between 45 and 65 years at the time of prosthesis implantation showed similar results. Conclusions: The present analysis shows that bPVE appears earlier than mPVE, even in the subgroup of patients aged 45\u201365. bPVE has more healthcare-related infections and more paravalvular complications. After adjusting for baseline differences, mPVE had higher in-hospital mortality.<\/jats:p>","DOI":"10.3390\/jcm14248826","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T09:57:24Z","timestamp":1765879044000},"page":"8826","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical and Prognostic Differences Between Mechanical Versus Biological Prosthetic Infective Endocarditis\u2014A Nationwide Database Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9019-2584","authenticated-orcid":false,"given":"Juan Esteban","family":"de Villarreal-Soto","sequence":"first","affiliation":[{"name":"Cardiac Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0369-9369","authenticated-orcid":false,"given":"Jorge Calder\u00f3n","family":"Parra","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5706-5583","authenticated-orcid":false,"given":"Patricia","family":"Mu\u00f1oz Garc\u00eda","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28010 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregorio Cuerpo","family":"Caballero","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, Gregorio Mara\u00f1on University Hospital, 28010 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina Machado","family":"V\u00edlchez","sequence":"additional","affiliation":[{"name":"Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Mara\u00f1\u00f3n, 28010 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7393-2501","authenticated-orcid":false,"given":"Maria \u00c1ngeles","family":"Rodr\u00edguez-Esteban","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4476-4630","authenticated-orcid":false,"given":"Raquel","family":"Rodriguez-Garcia","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Hospital Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valent\u00edn","family":"Tascon-Quevedo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, Hospital Universitario Marques de Valdeclla\u2014IDIVAL, 39008 Santander, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1983-3742","authenticated-orcid":false,"given":"Ane Josune","family":"Goikoetxea-Agirre","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Universitario de Cruces, 48903 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5386-7463","authenticated-orcid":false,"given":"Eduard","family":"Quintana Obrador","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, Hospital Cl\u00ednic of Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3532-4681","authenticated-orcid":false,"given":"Miguel Angel","family":"Goenaga-Sanchez","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Universitario Donosti, 20014 San Sebasti\u00e1n, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Garcia-Vazquez","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Cl\u00ednico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Hernandez-Estefania","sequence":"additional","affiliation":[{"name":"Cardiac and Thoracic Surgery Department, Hospital Universitario Fundaci\u00f3n Jim\u00e9nez D\u00edaz, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4840-9425","authenticated-orcid":false,"given":"Antonio","family":"Ramos Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos Esteban","family":"Martin-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1001\/jama.297.12.1354","article-title":"Contemporary Clinical Profile and Outcome of Prosthetic Valve Endocarditis","volume":"297","author":"Wang","year":"2007","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e002269","DOI":"10.1136\/openhrt-2023-002269","article-title":"Temporal trends in the incidence of infective endocarditis in patients with a prosthetic heart valve","volume":"10","author":"Jensen","year":"2023","journal-title":"Open Heart"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ramos-Mart\u00ednez, A., Dom\u00ednguez, F., Mu\u00f1oz, P., Mar\u00edn, M., Pedraz, \u00c1., Fari\u00f1as, M.C., Tasc\u00f3n, V., de Alarc\u00f3n, A., Rodr\u00edguez-Garc\u00eda, R., and Mir\u00f3, J.M. (2023). Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0290998"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/j.jiph.2024.03.011","article-title":"Trends in epidemiology, surgical management, and prognosis of infective endocarditis during the XXI century in Spain: A population-based nationwide study","volume":"17","author":"Cobo","year":"2024","journal-title":"J. Infect. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"ezaf047","DOI":"10.1093\/ejcts\/ezaf047","article-title":"Mid-term outcomes of intervalvular fibrosa body reconstruction with Commando variants for active infective endocarditis","volume":"67","author":"Sandoval","year":"2025","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1001\/archinte.168.19.2095","article-title":"Current features of infective endocarditis in elderly patients: Results of the International Collaboration on Endocarditis Prospective Cohort Study","volume":"168","author":"Bradley","year":"2008","journal-title":"Arch. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/j.jacc.2024.01.037","article-title":"The Clinical Challenge of Prosthetic Valve Endocarditis: JACC Focus Seminar 3\/4","volume":"83","author":"Cuervo","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.jtcvs.2019.09.186","article-title":"Surgical results for prosthetic versus native valve endocarditis: A multicenter analysis","volume":"161","author":"Weber","year":"2021","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Salem, M., Friedrich, C., Saad, M., Frank, D., Salem, M., Puehler, T., Schoettler, J., Schoeneich, F., Cremer, J., and Haneya, A. (2021). Active Infective Native and Prosthetic Valve Endocarditis: Short- and Long-Term Outcomes of Patients after Surgical Treatment. J. Clin. Med., 10.","DOI":"10.3390\/jcm10091868"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.athoracsur.2011.10.063","article-title":"Outcomes after surgical treatment of native and prosthetic valve infective endocarditis","volume":"93","author":"Manne","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Calder\u00f3n-Parra, J., de Villarreal-Soto, J.E., Oteo-Dom\u00ednguez, J.F., Mateos-Seirul, M., R\u00edos-Rosado, E., Dorado, L., Vera-Puente, B., Arellano-Serrano, C., Ramos-Mart\u00ednez, A., and Forteza-Gil, A. (2023). Risk of Infective Endocarditis Associated with Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement: A Propensity Score-Based Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020586"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.jacc.2022.11.028","article-title":"Infective Endocarditis After Transcatheter Aortic Valve Replacement: JACC State-of-the-Art Review","volume":"81","author":"Panagides","year":"2023","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_13","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. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1007\/s15010-024-02302-0","article-title":"Clinical characteristics and outcomes of aortic prosthetic valve endocarditis: Comparison between transcatheter and surgical bioprostheses","volume":"52","author":"Olmos","year":"2024","journal-title":"Infection"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"586","DOI":"10.7326\/0003-4819-150-9-200905050-00004","article-title":"Health care-associated native valve endocarditis: Importance of non-nosocomial acquisition","volume":"150","author":"Benito","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Caus, T., Chabry, Y., Nader, J., Fusellier, J.F., De Brux, J.L., and for the EpiCard investigators (2023). Trends in SAVR with biological vs. mechanical valves in middle-aged patients: Results from a French large multi-centric survey. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1205770"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1161\/CIRCULATIONAHA.114.014089","article-title":"Infective endocarditis after transcatheter aortic valve implantation: Results from a large multicenter registry","volume":"131","author":"Eltchaninoff","year":"2015","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jhin.2018.05.014","article-title":"In-hospital infective endocarditis following transcatheter aortic valve replacement: A cross-sectional study of the National Inpatient Sample database in the USA","volume":"100","author":"Yeo","year":"2018","journal-title":"J. Hosp. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2112","DOI":"10.1016\/j.amjcard.2018.08.054","article-title":"Comparison of incidence, predictors, and outcomes of early infective endocarditis after transcatheter aortic valve implantation versus surgical aortic valve replacement in the United States","volume":"122","author":"Kolte","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1016\/j.athoracsur.2015.07.082","article-title":"Surgical Treatment of Aortic Prosthetic Valve Endocarditis: A 20-Year Single-Center Experience","volume":"101","author":"Perrotta","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/j.ejcts.2009.11.035","article-title":"Aortic valve replacement for active infective endocarditis: 5-year survival comparison of bioprostheses, homografts and mechanical prostheses","volume":"37","author":"Nguyen","year":"2010","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1016\/j.recesp.2020.04.010","article-title":"Predictive model of in-hospital mortality in left-sided infective endocarditis","volume":"73","author":"Vilacosta","year":"2020","journal-title":"Rev. Esp. Cardiol. Engl. Ed."},{"key":"ref_23","first-page":"1","article-title":"Risk Factors for In-Hospital Mortality in Infective Endocarditis","volume":"114","author":"Marques","year":"2020","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.athoracsur.2019.10.029","article-title":"Incidence and Surgical Outcomes of Patients With Native and Prosthetic Aortic Valve Endocarditis","volume":"110","author":"Luehr","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Tao, E., Wan, L., Wang, W., Luo, Y., Zeng, J., and Wu, X. (2017). The prognosis of infective endocarditis treated with biological valves versus mechanical valves: A meta-analysis. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174519"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8826\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T11:13:07Z","timestamp":1765883587000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8826"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,13]]},"references-count":25,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248826"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248826","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,13]]}}}