Surgical treatment of prosthetic valve endocarditis

From January 1980 to June 1987, a total of 16 consecutive patients underwent surgical therapy in addition to an antimicrobial regimen for prosthetic valve endocarditis at the National Taiwan University Hospital. The ages ranged from 26 to 55 years, with a mean of 40. Nine of these 16 patients (56%) were men and 7 (44%) women. The infected valve prostheses were located at the aortic position in 5 patients, at the mitral position in 6 patients and at both mitral and aortic position in 5 patients. Among the total of 21 infected valve prostheses, 19 were bioprosthetic tissue valves and only 2 were mechanical valve prostheses. Hospital death occurred in 5 patients with an early mortality rate of 31%. Among them, 1 had fungal infection, 2 had streptococcal infection, and 2 had enterococcal infection. Four patients died of low cardiac output due to extensive myocardial involvement and one patient died of uncontrollable upper gastrointestinal bleeding. Late mortality occurred in 1 patient with fungal endocarditis and the cause of death was clinical deterioration due to multiple organ failure. The follow-up period ranged from 7 to 93 months. Except for one who was lost to follow-up, all of the patients survived in good condition without any complication.