AbstractBackgroundWe wanted to investigate the influence of native‐valve infective endocarditis (IE) on long‐term outcomes of surgical aortic valve replacement (SAVR).MethodsNative‐valve patients with IE (n = 191) were compared to propensity score‐matched patients without IE (n = 191), all treated with SAVR, in a multicentre, population‐based cohort register study in Finland. The median follow‐up was 6.2 years.ResultsInfective endocarditis as the indication for SAVR was associated with an increased hazard of 10‐year mortality (37.1% vs 24.2%; HR 1.83; CI 1.03‐3.26; P = .039). Ischaemic stroke was also more frequent in IE patients during 10‐year follow‐up (15.8% vs 7.5%; HR 3.80; CI 1.42‐10.18; P = .008). Major bleeding within first year after SAVR was more frequent in patients with IE (7.0% vs 2.9%; P = .038). Ten‐year major bleeding rate was 32.4% in IE vs 24.5% in non‐IE groups (P = .174). Aortic valve re‐operation rate was 4.3% in IE vs 8.4% in non‐IE groups (P = .975). Admission duration after SAVR was longer in IE (median 29 vs 9 days; P < .0001). There was no difference in 30‐day mortality after SAVR.ConclusionsPatients with native‐valve IE have a higher risk of death, ischaemic stroke, and early major bleeding after SAVR than matched patients without IE. Results confirm the high risk for complications of IE patients after SAVR and highlight the importance of vigorous prevention of both stroke and bleeding after SAVR in these patients.