Surgical Treatment of Infective Endocarditis at Comprehensive versus Primary Valve Centers

Abstract Background A recent expert consensus statement proposed designation of comprehensive and primary valve centers, with a recommendation that comprehensive centers house surgical skill and resources to treat patients with infective endocarditis (IE). We sought to compare outcomes of patients undergoing valve surgery for IE at comprehensive versus primary valve centers within a large healthcare system. Methods We reviewed 513 consecutive patients undergoing IE surgery at eight hospitals (2 comprehensive and 6 primary valve centers) from 2014-2020. Outcomes from comprehensive and primary valve centers were compared after propensity-score matching based on patient characteristics, valve involvement, valve type, and IE treatment status. Multivariate logistic regression was used to identify risk factors for operative mortality. Results Propensity-score matching generated comparable groups with similar mean STS/Gaca IE risk scores among comprehensive and primary valve center cohorts. Comprehensive valve centers were more likely to perform Bentall procedure (60.4% vs 21.7%, p Conclusions An increased risk for operative mortality was associated with surgery performed at primary valve centers as compared to comprehensive valve centers. Referral or transfer of patients with IE and surgical indications to comprehensive valve centers should be considered.