Bioprosthetic versus mechanical valve replacement in patients with infective endocarditis

During the 5-year period, 1979-1984, at the Texas Heart Institute, 4,598 patients underwent cardiac valve replacement procedures of which 185 were for acute infective endocarditis. Staphylococcus and streptococcus accounted for 80% of the cases and congestive heart failure was a leading indication in 63%. The purpose of this article is to evaluate the recurrence of endocarditis dependent upon whether the patient had an Ionescu-Shiley bioprosthetic pericardial valve or a mechanical valve (St. Jude Medical). Actuarial freedom from both early and late reoperation was higher for prosthetic valves than bioprosthetic valve patients. We conclude that mechanical valves are the valves of choice in acute infective endocarditis which apparently is the results of less biologic tissue available for exposure to infection by the offending organisms.