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Prosthetic valve endocarditis.

W R Wilson, P M Jaumin, G K Danielson

    Annals of Internal Medicine
    |June 1, 1975
    PubMed
    Summary
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    Prosthetic valve endocarditis (PVE) is serious, with high mortality, especially early after surgery. While medical therapy can cure some survivors, prompt surgical intervention is crucial for treatment failures.

    Area of Science:

    • Cardiology
    • Infectious Diseases
    • Cardiac Surgery

    Background:

    • Prosthetic valve endocarditis (PVE) is a severe complication following cardiac valve replacement surgery.
    • Understanding the timing of onset, causative pathogens, and outcomes is crucial for effective management.

    Purpose of the Study:

    • To analyze the clinical characteristics, microbial etiology, and outcomes of prosthetic valve endocarditis.
    • To evaluate the effectiveness of medical and surgical treatments for PVE.
    • To provide recommendations for antimicrobial prophylaxis and treatment strategies.

    Main Methods:

    • Retrospective analysis of 45 patients diagnosed with prosthetic valve endocarditis between January 1963 and January 1974.
    • Categorization of patients into early-onset (within 2 months) and late-onset (more than 2 months) PVE groups.

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  • Identification of microbial isolates and assessment of treatment outcomes (mortality, cure rates).

    • Main Results:

    • Overall mortality for PVE was 56%, with significantly higher rates in early-onset (88%) versus late-onset (40%) cases.
    • Early-onset PVE was frequently associated with Staphylococcus aureus and Gram-negative bacilli, carrying high mortality.
    • Late-onset PVE commonly involved viridans streptococci and Gram-negative bacilli, with lower mortality rates.
    • Medical therapy alone achieved cure in 60% of survivors, while combined therapy was curative in 40% of survivors.

    Conclusions:

    • Prosthetic valve endocarditis presents distinct challenges based on onset timing and causative organisms.
    • Early-onset PVE, particularly with Staphylococcus aureus or Gram-negative bacilli, has a grave prognosis.
    • While medical therapy can be effective, timely surgical intervention is essential for patients who do not respond to medical treatment.