Abstract Body (Do not enter title and authors here): Background: Infective endocarditis (IE) remains a heterogenous disease with high rates of adverse outcomes, and approximately half of the cases warrant cardiac surgery. Recurrent IE occurs not infrequently and is associated with significant morbidity and healthcare costs, warranting further investigation into its incidence and risk factors in contemporary IE patients.

Aims: We aimed to evaluate the incidence and predictors of recurrent IE in a large contemporary cohort of patients undergoing IE surgery.

Methods: Consecutive patients undergoing IE surgery at the Cleveland Clinic between 2009-2022, excluding in-hospital mortality, were included in our prospective registry. Recurrent IE during follow-up was assessed, and multivariable Cox proportional hazards regression analysis was performed to evaluate predictors of recurrence.

Results/Data (Descriptive and Inferential Statistics): Amongst 2,029 IE surgery patients studied (age 55.3±16.1 years, female: 611 [30.1%]), 200 (9.9%) experienced recurrent IE during follow-up. The 1-, 5- and 10-year rates of freedom from recurrence were 93.7%, 85.8% and 80.9%, respectively. The Table presents the multivariable predictors of recurrent IE, including younger age, history of intravenous drug use, smoking, dialysis and lower hemoglobin, while female sex and Staphylococcus aureus bacteremia showed a trend towards being associated with recurrent IE.

Conclusion: Recurrent IE continues to occur in a significant minority of patients undergoing IE surgery, with key predictors identified. Our findings can assist clinicians with risk stratification and in targeting preventive therapy to reduce the rates of recurrent IE.