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Volume 14
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10.3390/jcm14248826
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Article

Clinical and Prognostic Differences Between Mechanical Versus Biological Prosthetic Infective Endocarditis—A Nationwide Database Study

by
Juan Esteban de Villarreal-Soto
1,*,
Jorge Calderón Parra
2,
Patricia Muñoz García
3,
Gregorio Cuerpo Caballero
4,
Marina Machado Vílchez
3,
Maria Ángeles Rodríguez-Esteban
5,
Raquel Rodriguez-Garcia
5,
Valentín Tascon-Quevedo
6,
Ane Josune Goikoetxea-Agirre
7,
Eduard Quintana Obrador
8,
Miguel Angel Goenaga-Sanchez
9,
Elisa Garcia-Vazquez
10,
Rafael Hernandez-Estefania
11,
Antonio Ramos Martínez
2 and
Carlos Esteban Martin-López
1
1
Cardiac Surgery Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain
2
Infectious Diseases Department, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Majadahonda, Spain
3
Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, 28010 Madrid, Spain
4
Cardiac Surgery Department, Gregorio Marañon University Hospital, 28010 Madrid, Spain
5
Intensive Care Unit, Hospital Central de Asturias, 33011 Oviedo, Spain
6
Cardiac Surgery Department, Hospital Universitario Marques de Valdeclla—IDIVAL, 39008 Santander, Spain
7
Infectious Diseases Department, Hospital Universitario de Cruces, 48903 Bilbao, Spain
8
Cardiovascular Surgery Department, Hospital Clínic of Barcelona, 08036 Barcelona, Spain
9
Infectious Diseases Department, Hospital Universitario Donosti, 20014 San Sebastián, Spain
10
Internal Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
11
Cardiac and Thoracic Surgery Department, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
 
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*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(24), 8826; https://doi.org/10.3390/jcm14248826 (registering DOI)
Submission received: 13 November 2025 / Revised: 2 December 2025 / Accepted: 11 December 2025 / Published: 13 December 2025
(This article belongs to the Section Cardiology)
Versions Notes

Abstract

Objectives: Infective endocarditis (IE) is a feared and life-threatening complication, requiring a multidisciplinary approach. Prosthetic valve endocarditis (PVE) accounts for 20–30% 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 45–65 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 45–65. bPVE has more healthcare-related infections and more paravalvular complications. After adjusting for baseline differences, mPVE had higher in-hospital mortality.
Keywords: endocarditis; valve surgery; mechanical prosthesis; biological prosthesis; registry endocarditis; valve surgery; mechanical prosthesis; biological prosthesis; registry

Share and Cite

MDPI and ACS Style

de Villarreal-Soto, J.E.; Parra, J.C.; Muñoz García, P.; Caballero, G.C.; Vílchez, M.M.; Rodríguez-Esteban, M.Á.; Rodriguez-Garcia, R.; Tascon-Quevedo, V.; Goikoetxea-Agirre, A.J.; Quintana Obrador, E.; et al. Clinical and Prognostic Differences Between Mechanical Versus Biological Prosthetic Infective Endocarditis—A Nationwide Database Study. J. Clin. Med. 2025, 14, 8826. https://doi.org/10.3390/jcm14248826

AMA Style

de Villarreal-Soto JE, Parra JC, Muñoz García P, Caballero GC, Vílchez MM, Rodríguez-Esteban MÁ, Rodriguez-Garcia R, Tascon-Quevedo V, Goikoetxea-Agirre AJ, Quintana Obrador E, et al. Clinical and Prognostic Differences Between Mechanical Versus Biological Prosthetic Infective Endocarditis—A Nationwide Database Study. Journal of Clinical Medicine. 2025; 14(24):8826. https://doi.org/10.3390/jcm14248826

Chicago/Turabian Style

de Villarreal-Soto, Juan Esteban, Jorge Calderón Parra, Patricia Muñoz García, Gregorio Cuerpo Caballero, Marina Machado Vílchez, Maria Ángeles Rodríguez-Esteban, Raquel Rodriguez-Garcia, Valentín Tascon-Quevedo, Ane Josune Goikoetxea-Agirre, Eduard Quintana Obrador, and et al. 2025. "Clinical and Prognostic Differences Between Mechanical Versus Biological Prosthetic Infective Endocarditis—A Nationwide Database Study" Journal of Clinical Medicine 14, no. 24: 8826. https://doi.org/10.3390/jcm14248826

APA Style

de Villarreal-Soto, J. E., Parra, J. C., Muñoz García, P., Caballero, G. C., Vílchez, M. M., Rodríguez-Esteban, M. Á., Rodriguez-Garcia, R., Tascon-Quevedo, V., Goikoetxea-Agirre, A. J., Quintana Obrador, E., Goenaga-Sanchez, M. A., Garcia-Vazquez, E., Hernandez-Estefania, R., Martínez, A. R., & Martin-López, C. E. (2025). Clinical and Prognostic Differences Between Mechanical Versus Biological Prosthetic Infective Endocarditis—A Nationwide Database Study. Journal of Clinical Medicine, 14(24), 8826. https://doi.org/10.3390/jcm14248826

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