Prosthetic valve endocarditis: importance of surgical treatment

Surgical therapy of prosthetic valve endocarditis (PVE) is still associated with a high mortality of up to 80 %. Further risk analysis and characterization of clinical features are important for a further improvement of surgical results. The aim of this retrospective study was a risk analysis of clinical features of the pre-, intra-, and postoperative period. Between February 1998 and December 2004, 70 patients (52 male, 18 female, age 62 +/- 11 years) were referred to our institution for surgical therapy of PVE. This cohort included 16 patients with early PVE and 54 patients with late PVE. Preoperative, intraoperative and postoperative features were evaluated with respect to their influence on the early postoperative course and the midterm follow-up. The aortic valve was affected in 41 patients (58.6 %) and the mitral valve in 15 patients (21.4 %). Double valve infection was recorded in 14 patients (20.0 %). Staphylococci (n = 36, 51.4 %), Streptococci (n = 9, 12.9 %) and others (n = 24, 14.5 %) were identified as causative agents in blood cultures. The hospital mortality rate was 20.0 % (n = 14), during follow-up (mean follow up: 3.3 +/- 2.5 years), a further 11 patients (15.7 %) died, resulting in an overall mortality of 35.7 %. The main predictors for hospital mortality were preoperative heart failure ( P = 0.01) and Staphylococci infection ( P = 0.01). Predictors of overall mortality were Staphylococci infection ( P = 0.01), heart failure ( P = 0.02) and abscess formation ( P = 0.02). Surgical therapy of prosthetic valve endocarditis is still associated with quite a high mortality during the early and midterm follow-up. Predictors of outcome particularly include preoperative risk constellations (heart failure, Staphylococci infection).