Native Valve Infective Endocarditis Research Articles

Acute Coxiella burnetii Infection: A 10-Year Clinical Experience at a Tertiary Care Center in the United States.

Identifying and treating patients with acute Q fever who are at an increased risk of progressing to persistent disease is crucial for preventing future complications. In this study, we share our decade-long clinical experience with acute Q fever, highlighting the challenges that clinicians encounter from making an initial diagnosis and performing risk stratification to determining the appropriate prophylaxis regimen and duration. We retrieved records of adult Mayo Clinic patients (≥18 years) with positive Coxiella burnetii serology results between 1 January 2012 and 31 March 2022. Patients with Q fever anti-phase II immunoglobulin G ≥1:256 by indirect immunofluorescence were further analyzed. Thirty-one patients were included. Their median age was 58 years (IQR, 50-64), and the majority were men (84%). Acute hepatitis (29%), flu-like illness (25.8%), and pneumonia (16%) were the most common presentations. Thirteen patients (42%) received antibiotic prophylaxis to prevent disease progression, with significant variation in the indications and duration across physicians. The combination of doxycycline and hydroxychloroquine was the preferred regimen. Prophylaxis was administered for a median 333 days (IQR, 168-414). Four patients (13%) progressed to Q fever native valve infective endocarditis, with elevated anticardiolipin immunoglobulin G levels being the sole risk factor in 2 cases. The small sample size precluded drawing conclusions on the impact of prophylaxis in preventing disease progression. Management of acute Q fever is complicated by the lack of comprehensive clinical guidelines leading to varied clinical practices. There is a critical need for randomized trials to establish robust evidence-based protocols for management.

Acute heart failure in patients with valvular infective endocarditis: a one-year consecutive cohort from a Spanish tertiary centre

Abstract Funding Acknowledgements None. Background Infective endocarditis (IE) is associated with substantial morbidity and mortality. Acute decompensated heart failure (AHF) is a frequent complication of IE and it is often an indication for urgent cardiac surgery. Purpose The aim of this study was to describe clinical data and short term outcomes of patients admitted for valvular IE complicated with AHF. Methods We collected data from all the patients with IE admitted or referred to our Spanish tertiary centre from September 1st, 2022 to August 31st, 2023. Patients with non-valvular IE were not included. Results Two patients did not consent to participate in the study. 87 consenting patients were included. Of them, 38 (44%) presented with AHF, of whom 14 (16.1%) had acute pulmonary oedema, and 6 (6.9%) suffered cardiogenic shock. Mean age was 67.4 years old in the AHF group vs 64.0 in patients without AHF (non significant), 74% of male sex in both groups, Charlson Comorbidity Index of 4.9 vs 5.6 points (n.s.); prosthetic-valve endocarditis was more frequent in the AHF group compared to patients without AHF (42% vs 28%, p < 0.05). Urgent cardiac surgery was indicated in 91% of patients with AHF vs 44% of patients without heart failure (p < 0.01); when indicated, surgery was eventually performed in 65% vs 57% of the patients (n.s.). In AHF patients with surgical indication, in-hospital mortality rate was significantly higher in those that did not undergo surgery (64% vs 16%, p < 0.01). Compared to native-valve IE, prosthetic-valve IE was associated with higher rates of AHF (42% vs 28%, p < 0.05). In-hospital mortality rate was significantly higher in AHF patients (33.3% vs 3.0%, p < 0.01). Acute pulmonary oedema and cardiogenic shock patients had the highest in-hospital mortality (respectively, 43% and 67%). Similarly, mortality rate 30 days after hospital discharge was higher in the AHF group (16.0% vs 6.3%, p < 0.05). Conclusions In this population, presentation with AHF was associated with worse short-term outcomes. Surgery was indicated in the majority of AHF patients, and not performing it was associated with worse outcome.

Calcium polystyrene sulfonate-induced rectal ulcer causing E. coli native-valve infective endocarditis.

Escherichia coli-associated native-valve infective endocarditis is a rare disease that affects elderly patients with underlying risk factors such as diabetes mellitus, malignancy, and renal failure. Long-term use of calcium polystyrene sulfonate is a potential risk factor for gastrointestinal mucosal damage or even colorectal ulcers. Herein, we describe a fatal case of a 66-year-old Japanese man with diabetes mellitus and renal failure who was prescribed calcium polystyrene sulfonate (CPS) for 11years and developed a CPS-induced rectal ulcer, leading to E. coli native-valve infective endocarditis. The patient was admitted to our hospital due to acute-onset impaired consciousness. As a result of the systemic investigation, he was diagnosed with E. coli bacteremia accompanied by multiple cerebral infarctions and an acute hemorrhagic rectal ulcer. Transesophageal echocardiography revealed a 20-mm vegetative structure on the mitral valve, resulting in a final diagnosis of E. coli-associated infective endocarditis. After rectal resection, mitral valve replacement surgery was performed; however, the patient died shortly after surgery. Pathological findings of the resected rectum showed deposition of a basophilic crystalline material suggesting the presence of CPS. Our case highlights the potential risk of colorectal ulcers in a long-term CPS user, which can trigger bacterial translocation and endocarditis as fatal complications.

Haemophilus influenzae endocarditis: a case report and literature review.

Haemophilus influenzae (HI) is an exceedingly rare cause of infective endocarditis (IE). We present a case of a 90-year-old female diagnosed with HI-IE involving the native tricuspid valve in the absence of traditional risk factors for right-sided endocarditis. She was treated with a 5-week course of IV Ampicillin from negative cultures and suffered no complications. We also conducted a thorough literature review through PubMed and Google Scholar, which yielded a mere 15 reported cases of HI-IE. Fourteen of the reported HI-IE cases included epidemiological data, showing no gender predominance. The mean age of the subjects was 39.5, with the mitral valve being the most implicated (64%) and tricuspid valve involvement being rare (21%). Native tricuspid valve IE is an uncommon entity, especially in the absence of IV drug use. Haemophilus influenzae is an extremely rare cause of IE, with a literature review showing merely 15 reported cases. This article cites the 16th case of HI-IE published in the literature.

Surgical repair and replacement for native mitral valve infective endocarditis.

The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001-2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients' profile between the repair and replacement subgroups. Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.

12 - A novel approach to vegetation aspiration in native valve infective endocarditis using the alphavac system

12 - A novel approach to vegetation aspiration in native valve infective endocarditis using the alphavac system

Characteristics, prognosis of native valve infective endocarditis complicated by heart failure

Characteristics, prognosis of native valve infective endocarditis complicated by heart failure

Trends of Infective Endocarditis at Two Teaching Hospitals: A 12-Year Retrospective Cohort Study in Rio de Janeiro, Brazil.

Despite advances in diagnosis and treatment, the incidence and mortality of infective endocarditis (IE) have increased in recent decades. Studies on the risk factors for mortality in endocarditis in Latin America are scarce. This retrospective cohort study included 240 patients diagnosed with IE according to the modified Duke criteria who were admitted to two university hospitals in Rio de Janeiro, Brazil from January 2009 to June 2021. Poisson regression analysis was performed for trend tests. The multivariate Cox proportional hazards model was used to estimate the hazard ratio (HR) of predictors of in-hospital mortality. The median age was 55 years (IQR: 39-66 years), 57% were male, and 41% had a Charlson comorbidity index (CCI) score > 3. Healthcare-associated infective endocarditis (54%), left-sided native valve IE (77.5%), and staphylococcal IE (26%) predominated. Overall, in-hospital mortality was 45.8%, and mortality was significantly higher in the following patients: aged ≥ 60 years (53%), CCI score ≥ 3 (60%), healthcare-associated infective endocarditis (HAIE) (53%), left-sided IE (51%), and enterococcal IE (67%). Poisson regression analysis showed no trend in in-hospital mortality per year. The adjusted multivariate model determined that age ≥ 60 years was an independent risk factor for in-hospital mortality (HR = 1.9; 95% CI 1.2-3.1; p = 0.008). In this 12-year retrospective cohort, there was no evidence of an improvement in survival in patients with IE. Since older age is a risk factor for mortality, consensus is needed for the management of IE in this group of patients.

68 Uncommon culprit: Can Staphylococcus epidermidis be a cause of native valve infective endocarditis in an injecting drug user?

68 Uncommon culprit: Can Staphylococcus epidermidis be a cause of native valve infective endocarditis in an injecting drug user?

Left-sided native valve infective endocarditis concomitant with severe valvular regurgitation: Prevalence, characteristics and prognostic factors

Abstract Background The characteristics of patients with left-sided native valve infective endocarditis and severe valvular regurgitation has never been studied. Purpose To analyze the prevalence of severe valvular regurgitation in patients with left-sided infective endocarditis, to describe in detail their characteristics and to determine the prognostic factors of these patients. Patients and methods We included in an ongoing multipurpose database, all patients with definite left-sided infective endocarditis admitted in three Spanish tertiary hospitals from 2005 to 2022. We describe the clinical, epidemiological, microbiological, echocardiographic characteristics of patients with severe valvular regurgitation and compared it with those without it. We also analyzed the independent factors of in-hospital mortality of these patients. Results Of a total of 874 patients with left-sided native valve infective endocarditis of our series, 564 had severe valvular regurgitation (65%). Comparison between patients with and without severe valvular regurgitation is shown in figure 1. Age (HR 1.035 95% CI 1.02-1.05), S. aureus (HR 2.26; 95% CI 1.26-4.1), vegetations (HR 3.7; 95% CI 1.2-11.4), heart failure (HR 2.76; 95% IC 1.5-5.1), renal failure (HR 3.1; 95% CI 1.9-4.9) and septic shock (HR 4.3; 95% CI 2.29-8) were the independent factors of in hospital mortality. On the contrary, cardiac surgery is an independent protector factor of mortality (HR 0.35; 95% CI 0.21-0.59). Conclusions A very high proportion of patients with definite left-sided infective endocarditis have severe valvular regurgitation in our series. Despite important epidemiological, clinical and echocardiographic differences with patients without it, the short-term prognosis is similar Surgery is an independent protective factor in these patients.

Abstract 12025: Utility of Intracardiac Echocardiography for Prosthetic Valve Infective Endocarditis and Cardiovascular Device-Related Infection: A Contemporary Systematic Review

Introduction: Infective endocarditis (IE), particularly prosthetic valve endocarditis (PVE) and cardiac device-related endocarditis (CDIE), presents significant diagnostic challenges. The efficacy of intra-cardiac echocardiography (ICE) for diagnosing IE and assessing intra-cardiac infections when transesophageal echocardiography (TEE) is contraindicated, is not extensively studied. Methods: We searched six databases, including PubMed, Embase, Scopus, Ovid, Science Direct, and Web of Science, for articles published between September 2002 and November 2022, related to the utility of ICE in IE. Eligibility screening followed the search. Results: From the 12 identified studies discussing ICE for IE diagnosis, ten cases of IE were highlighted in nine reports, and three cohort studies included 236 patients without individual patient details. ICE was not used in any native valve IE case. Predominantly male patients (90%) had a median age of 42 years, developing endocarditis 2.5 years post initial cardiac procedure. The most common microorganisms identified were Staphylococcus species. ICE proved beneficial in various scenarios, particularly PVE and CDIE, especially when echocardiography studies were inconclusive or contraindicated. As an alternative to TEE, ICE offers clear visualization of right heart structure, guiding interventions such as pacemaker lead extractions. It excels in detecting device lead abnormalities and small vegetations in CDIE cases, supporting risk stratification and preparation for infected device extraction. Notably, all PVE cases involved bioprosthetic valves, affecting various heart structures and valves. Conclusion: This systematic review highlights ICE as an adjunct imaging modality in IE, especially in PVE and CDIE when TEE is contraindicated. Preliminary data suggest its valuable role during intracardiac lead extractions.

Abstract 19189: A Rare Case of Neisseria Gonorrhoeae Native Aortic Valve Infective Endocarditis With Development of Gerbode Defect

Introduction: Infective endocarditis (IE) is a devastating condition most commonly caused by gram-positive cocci ( S. aureus , S. viridans , S. gallolyticus , Enterococcus spp.) and gram-negative organisms (e.g. HACEK organisms). We present a case of Native Aortic Valve IE due to disseminated N. Gonorrhea in an immunocompetent patient. Hospital Course: The patient is a 30-year-old female who presented with a chief complaint of subacute chest pain and constitutional symptoms. Echocardiography revealed aortic valve abscess and severe aortic insufficiency with concerns of aorto-atrial fistula. The patient was treated with antibiotics and transferred to our hospital. Upon transfer, the patient was initially stable. Physical exam was notable for a pandiastolic murmur. The patient rapidly deteriorated into cardiogenic and septic shock. TTE revealed aortic root abscess, LVOT-RA fistula (Gerbode defect), and right atrial vegetation. Emergent surgical exploration revealed IE of the aortic valve with destruction of right and non-coronary cusps and vegetation eroding from the base of the aortic root through the membranous septum to the right atrium without tricuspid valve involvement. She underwent successful treatment with debridement and reconstruction. Initial blood cultures were positive for N. gonorrhoeae. The patient was negative for HIV and no gynecologic source was identified. After an extended hospital course, the patient was discharged with IV antibiotics. Discussion & Conclusion: We present a rare case of N. Gonorrhoeae aortic valve endocarditis leading to aortic valve destruction with subsequent abscess and fistulae formation. This case demonstrates a rare and severe consequence of disseminated gonococcal infections (DGI), though the patient was without other manifestations of DGI.

Clinical and morphological features of infective endocarditis of native and prosthetic heart valves

Aim. To evaluate clinical and morphological data of infective endocarditis (IE) of native and prosthetic heart valves.Material and methods. This retrospective cohort study included 354 patients that had signs of IE according to pathological study of surgical material from native valves and prosthetic heart valves. The patients were divided into two groups: the first group included patients with native valve IE (n=328), while the second group — with prosthetic valve IE (n=26).Results. Among patients with native valve IE, aortic (AV) and mitral valve (MV) IE was recorded in 67,6% and 20,7%, respectively. In the group of patients with prosthetic IE, AV IE also predominated — 57,7% vs 26,9% in MV IE. In the majority of patients in the first group, secondary IE was detected (68,9%). The development of IE in the presence of bicuspid AV (BAV), degenerative AV disease, and rheumatic valve disease was revealed in 40,7%, 31,4% and 6,7%, respectively. In the group of patients with native valve IE, subactive IE was most often detected — in 38,4%, while in 7,1% — signs of process remission were detected. In the group of patients with prosthetic valve IE, IE with moderate activity was detected more often than in the group of patients with native valve IE (42,3% vs 26,8%, p=0,042). In the group of patients with prosthetic valve IE, the presence of colonies of microorganisms and neutrophilic infiltration in the histological material was somewhat more common, while in patients with native valve IE there was a tendency towards a higher percentage of necrosis in the studied material (42,4% vs 38,5%, p>0,05).Conclusion. This work confirms changes in the epidemiological characteristics of patients with IE. A high frequency of subactive forms of IE was noted according in patients with native valve IE, which requires individual approach to antibacterial therapy depending on the pathomorphological IE activity.

A Rare Case of Postpartum Native Tricuspid Valve Infective Endocarditis with Septic Pulmonary Embolization

Infective endocarditis (IE) is a rare life-threatening infection in pregnancy and postpartum period. In 90% of cases, right-sided IE involves the tricuspid valve. This case report illustrates acute IE with native tricuspid valve vegetation with septic pulmonary embolization in immediate postpartum period.

Surgical management of infective endocarditis: an analysis of early and 1 year result in native valve patients at vietnam heart institute from 2018 to 2019

Background: about 50% of infective endocarditis patients require surgery, but mortality and complications rates are still high, both the immediate postoperative period and 1 year follow-up.
 Study: To find out the early (first 30 days) and up to 1 year mortality and complication rates in native valve infective endocarditis patients after surgery. [1]
 Subjects and methods: 66 native valve infective endocarditis patients were operated at the Vietnam Heart Institute- Bach Mai Hospital, followed up to 1 year after surgery.
 Methods: longitudinal follow-up retrospective, cross-sectional observational study.
 Results: The mortality rate in the first 30 days was 9.1%, the additional mortality rate after 1 year was 1.7%, the cumulative mortality rate up to 1 year after surgery was 10.6. %, the survival rate was 89.4%. IE recurrence rate was 1.5%. The most common complications in the early postoperative period: renal failure (9.1%) and pleural effusion (9.1%), pneumonia (6.1%) cerebrovascular accident (3%) and atrioventricular block (1.5%). Follow- up to 1 year, 33.3% of patients had to be re-hospitalized due to cardiovascular events.

Contemporary Clinical Profile of Left-Sided Native Valve Infective Endocarditis: Influence of the Causative Microorganism.

Studies focused on the clinical profile of native valve endocarditis are scarce and outdated. In addition, none of them analyzed differences depending on the causative microorganism. Our objectives are to describe the clinical profile at admission of patients with left-sided native valve infective endocarditis in a contemporary wide series of patients and to compare them among the most frequent etiologies. To do so, we conducted a prospective, observational cohort study including 569 patients with native left-sided endocarditis enrolled from 2006 to 2019. We describe the modes of presentation and the symptoms and signs at admission of these patients and compare them among the five more frequent microbiological etiologies. Coagulase-negative Staphylococci and Enterococci endocarditis patients were the oldest (71 ± 11 years), and episodes caused by Streptococci viridans were less frequently nosocomial (4%). The neurologic, cutaneous or renal modes of presentation were more typical in Staphylococcus aureus endocarditis (28%, p = 0.002), the wasting syndrome of Streptococcus viridans (49%, p < 0.001), and the cardiac in Coagulase-negative Staphylococci, Enterococci and unidentified microorganism endocarditis (45%, 49% and 56%, p < 0.001). The clinical signs agreed with the mode of presentation. In conclusion, the modes of presentation and the clinical picture at admission were tightly associated with the causative microorganism in patients with left-sided native valve endocarditis.

Native Valve Infective Endocarditis Associated with Ruptured Right Sinus of Valsalva: A Case Report

Endocarditis is defined as an infection of the cardiac endothelium. The incidence occurs from 2 to 10 cases per 100,000 people/year. Cardiovascular complications, including cardiac arrest, cardiogenic shock, myocardial infarction, acute heart failure, and heart block. The case of a 51-year-old male patient with fever, asthenia, adynamia, and chills is presented, evolving to shock data to determine the origin, requiring management with vasopressor, a diagnostic protocol with transthoracic echocardiogram is performed where calcified aortic valve and mass attached to the valve ring and image suggestive of abscess at the level of the sinuses of Valsalva are observed. Transesophageal echocardiogram, in addition to the vegetation previously described and the abscess in the mitro-aortic continuity, tricuspid valve lesion with rupture of the sinus of Valsalva. Consultation was requested for cardiothoracic surgery with aortic valve replacement due to a N23 mechanical valve, with closure of the right sinus of Valsalva ruptured to the right ventricle infective endocarditis of the aortic and tricuspid valve with clinical improvement if any eventualities occurred. Rupture of the sinus of Valsalva with fistulization towards lower-pressure cavities (generally the right atrium and ventricle) is probably the most frequent form of presentation. Accurate diagnosis of complicated infective endocarditis means the difference between a good evolution and a poor prognosis.

Patient Characteristics, Microbiology, and Mortality of Infective Endocarditis After Transcatheter Aortic Valve Implantation.

Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI. Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, early (≤12 m), and late IE (>12 m) microbiology; and unadjusted and adjusted mortality were compared. We identified 273, 1022, and 5376 cases of IE after TAVI, IE after nTPV, and native valve IE. Age and frailty were highest among TAVI IE (4.8%; median age: 82 y; 61.9% frail). Enterococcus spp. were common for IE after TAVI (27.1%) and IE after nTPV (21.2%) compared with native valve IE (11.4%). Blood culture-negative IE was rare in IE after TAVI (5.5%) compared with IE after nTPV (15.2%) and native valve IE (13.5%). The unadjusted 90-day mortality was comparable, but the 5-year mortality was highest for IE after TAVI (75.2% vs 57.2% vs 53.6%). In Cox models adjusted for patient characteristics and bacterial etiology for 1-90 days and 91-365 days, there was no significant difference in mortality rates. Patients with IE after TAVI are older and frailer, enterococci and streptococci are often the etiologic agents, and are rarely blood culture negative compared with other IE patients. Future studies regarding antibiotic prophylaxis strategies covering enterococci should be considered in this setting.

Anévrysme rénal infectieux retardé, 3 mois après chirurgie cardiaque pour une endocardite infectieuse à Streptococcus pyogenes ; cas et revue de la littérature

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature.We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts.He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization.This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

Twenty-Year Experience with Surgery for Native and Prosthetic Mitral Valve Endocarditis.

Background and Objectives: To evaluate the early and long-term results of surgical treatment of isolated mitral native and prosthetic valve infective endocarditis. Materials and Methods: All patients undergoing mitral valve repair or replacement for infective endocarditis at our institution between January 2001 and December 2021 were included in the study. The preoperative and postoperative characteristics and mortality of patients were retrospectively reviewed. Results: A total of 130 patients, 85 males and 45 females, with a median age of 61 ± 14 years, underwent surgery for isolated mitral valve endocarditis during the study period. There were 111 (85%) native and 19 (15%) prosthetic valve endocarditis cases. Fifty-one (39%) patients died during the follow-up, and the overall mean patient survival time was 11.8 ± 0.9 years. The mean survival time was better in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (12.3 ± 0.9 years vs. 8 ± 1.4 years; p = 0.1), but the difference was not statistically significant. Patients who underwent mitral valve repair had a better survival rate compared to patients who had mitral valve replacement (14.8 ± 1.6 vs. 11.3 ± 1 years; p = 0.06); however, the difference was not statistically significant. Patients who underwent mitral valve replacement with a mechanical prosthesis had a significantly better survival rate compared to patients who received a biological prosthesis (15.6 ± 1.6 vs. 8.2 ± 0.8 years; p < 0.001). Patients aged ≤60 years had significantly better survival compared to patients aged >60 years (17.1 ± 1.1 vs. 8.2 ± 0.9; p < 0.001). Multivariate analysis showed that the patient's age >60 years at the time of surgery was an independent risk factor for mortality, while mitral valve repair was a protective factor. Eight (7%) patients required reintervention. Freedom from reintervention was significantly higher in patients with mitral native valve endocarditis compared to patients with prosthetic valve endocarditis (19.3 ± 0.5 vs. 11.5 ± 1.7 years; p = 0.04). Conclusions: Surgery for mitral valve endocarditis is associated with considerable morbidity and mortality. The patient's age at the time of surgery represents an independent risk factor for mortality. Mitral valve repair should be the preferred choice whenever possible in suitable patients affected by infective endocarditis.