[Prosthesis endocarditis: incidence, diagnosis, therapeutic decisions and prognosis]

In 2711 patients with heart valve replacement performed between 1965 and 1986 the cumulative incidence of prosthetic valve endocarditis (PVE) was 1.19 +/- 0.24% (n = 61). In patients operated on before 1976 (group A; n = 583) early PVE was observed in 3.43%, and in patients operated on between 1976 and 1986 (group B; n = 2128) in only 0.42%. PVE after the 60th postoperative day occurred with a linear incidence of 0.21 events per 100 patient-years (A: 0.11%; B: 0.27%). In 54% of PVE cases the aortic, and in 34% the mitral was involved; in 12% both left-sided prostheses were involved after double valve replacement. In the four weeks before the manifestation of initial symptoms of PVE, bacterial infections and diagnostic or therapeutic interventions had occurred in 74.2%. All interventions had been performed without endocarditis prophylaxis. Diagnosis of PVE was established in 57% by history and clinical examination, in 20% by microbiologic examinations and in 12% by echocardiography. Due to improved diagnostic methods and earlier surgical intervention, mortality declined during the follow-up period from 81% (1965-1970) to 18% (1981-1986). The prognosis was worse in patients who developed therapy-resistant heart failure due to hemodynamically significant prosthetic valve malfunction, or who had sepsis that persisted for more than 72 hours despite antibiotic therapy, major septic embolism or acute renal failure. The retrospective prognosis was more favourable for patients with early valve re-replacement than for patients who had been treated medically alone.