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Prosthetic valve endocarditis
M J Janatuinen1, E A Vänttinen, V Rantakokko
1Department of Surgery, University Central Hospital, Turku, Finland.
Abstract:
Prosthetic valve endocarditis is an infrequent but serious complication of valve surgery. It occurred in 25 (3.2%) of 772 patients who received aortic, mitral or double valve replacement in 1971-1987. The total follow-up time was 3,976 patient years, giving an incidence of 0.63/100 patient years. Staphylococci were the most common of the cultured organisms in early and late infections-60% and 64%, respectively. The endocarditis was disclosed at autopsy in two cases. Treatment was antibiotics alone in 11 cases, and surgery was required in 12, the indication always being congestive heart failure. C-reactive protein level fell more rapidly than erythrocyte sedimentation rate in response to antibiotic or surgical management. The mortality rate was 73% in the antibiotic group and 33% in the surgical group. The findings demonstrated that an infected valve prosthesis should be replaced without delay if complications develop.
Insights
Prosthetic valve endocarditis is a serious complication of valve replacement surgery. Early surgical intervention for infected prosthetic valves significantly improves patient survival rates compared to antibiotic treatment alone.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Prosthetic valve endocarditis (PVE) is a rare but severe complication following valve replacement surgery.
- The incidence of PVE in patients undergoing aortic, mitral, or double valve replacement between 1971-1987 was 3.2%.
Purpose of the Study:
- To determine the incidence, causative organisms, treatment outcomes, and mortality rates associated with prosthetic valve endocarditis.
- To evaluate the efficacy of different management strategies for PVE.
Main Methods:
- Retrospective analysis of 772 patients who underwent valve replacement surgery from 1971 to 1987.
- Follow-up data spanning 3,976 patient-years to assess PVE incidence.
- Comparison of outcomes between antibiotic-only and surgical treatment groups.
Main Results:
- The overall incidence of PVE was 0.63 per 100 patient-years.
- Staphylococci were the predominant pathogens in both early and late PVE.
- Surgical intervention, indicated by congestive heart failure, resulted in a 33% mortality rate, significantly lower than the 73% mortality in the antibiotic-only group.
- C-reactive protein levels decreased faster than erythrocyte sedimentation rates during treatment.
Conclusions:
- Infected prosthetic valves require prompt surgical replacement, especially when complications like congestive heart failure arise.
- Surgical management of PVE offers a survival advantage over antibiotic therapy alone.
- Staphylococcal infections are a major concern in PVE.