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[Infective endocarditis of a valve prosthesis. Multicenter study (179 cases)]
G Hanania1, D Thomas, J M Montely
1Service de cardiologie, centre hospitalier général Robert-Ballanger, Aulnay-sous-Bois.
Insights
Infective endocarditis on prosthesis (IEP) affects males more often and occurs early or late. Early IEP is frequently staphylococcal, while late IEP is often streptococcal, impacting surgical outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis on prosthesis (IEP) is a serious complication following valve replacement surgery.
- Understanding the epidemiology and outcomes of IEP is crucial for patient management.
Purpose of the Study:
- To analyze the characteristics, treatment, and outcomes of infective endocarditis on prosthesis (IEP).
- To identify risk factors and differences between early and late onset IEP.
Main Methods:
- A retrospective study of 176 IEP cases recorded over a 5-year period (1982-1986) across 40 cardiology departments.
- Analysis of patient demographics, prosthesis type, causative organisms, treatment strategies, and mortality rates.
Main Results:
- Mechanical prostheses were more frequently involved (57%) than bioprostheses (43%).
- Early IEP (40 cases) was often staphylococcal (48%), while late IEP (139 cases) was more frequently streptococcal (31%).
- Abscesses were more common with aortic prostheses (58%) than mitral (20%). Operative mortality was 25%, higher in unoperated patients (31%).
Conclusions:
- IEP presents diverse clinical patterns based on onset time and prosthesis type.
- Prompt reoperation and appropriate antibiotic therapy are critical, though mortality remains high.
- Survival rates in operated IEP patients were slightly better than in unoperated ones.
Abstract:
Over a 5-year period (1982-1986) 176 cases of infective endocarditis on prosthesis (IEP) were recorded in 40 cardiology departments. 65 p. 100 of the patients were male, and the mean age of the population was 51 years. Mechanical prostheses were involved in 57 p. 100 of the cases and bioprosthesis in 43 p. 100. There was a high proportion of initial indications for bacterial endocarditis (18 p. 100) and for reoperation on prosthesis (10 p. 100). IEP developed early in 40 cases and late in 139 cases; 19 (48 p. 100) of the early IEPs were staphylococcal, while 31 p. 100 of late IEPs were streptococcal (p less than 0.01). 143 patients were reoperated upon within less than 1 month in 41 p. 100 of the cases, with a pre-operative antibiotic therapy of less than 10 days in 39 p. 100. Reoperation was performed in stage IV or as an emergency in 45 p. 100 of the cases. Abscesses were three times more frequent with aortic prostheses than with mitral prostheses (58 p. 100 vs 20 p. 100, p less than 0.001). Vegetations were more frequent on mechanical prostheses than on bioprostheses (43 p. 100 vs 31 p. 100, NS). The operative mortality rate was 25 p. 100; the mortality rate of unoperated patients was even higher (31 p. 100). The survival rate in operated IEP was 51 p. 100 at 30 months, as against 46 p. 100 at 12 months in unoperated IEP.(ABSTRACT TRUNCATED AT 250 WORDS)