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A practical approach to prosthetic valve endocarditis.

L D Cowgill, V P Addonizio, A R Hopeman

    The Annals of Thoracic Surgery
    |April 1, 1987
    PubMed
    Summary
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    Prosthetic valve endocarditis (PVE) is a rare complication. Early diagnosis via blood cultures and prompt valve replacement surgery significantly improve survival rates for patients with PVE.

    Area of Science:

    • Cardiology
    • Infectious Diseases
    • Cardiac Surgery

    Background:

    • Prosthetic valve endocarditis (PVE) is an infrequent but serious complication following valve replacement surgery.
    • It occurs in 1-2% of patients early or late postoperatively.
    • Diagnosis can be challenging due to potential confounding factors like exogenous bacteremia, culture-negative cases, and skin contaminants.

    Purpose of the Study:

    • To review the diagnostic challenges and management strategies for prosthetic valve endocarditis (PVE).
    • To highlight the importance of early surgical intervention in improving patient survival.
    • To discuss preventive measures and their limited impact on the already low incidence of PVE.

    Main Methods:

    • Review of diagnostic criteria for PVE, emphasizing blood cultures.

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  • Discussion of management protocols based on the source of bacteremia (exogenous vs. skin contaminants).
  • Analysis of factors influencing survival, particularly the role of earlier surgical intervention (valve rereplacement).

    • Main Results:

    • Blood cultures are highly effective (99%) for diagnosing PVE.
    • Management strategies vary depending on the source of infection, with specific antibiotic durations recommended.
    • Earlier valve rereplacement surgery is the primary driver of improved survival in recent years.

    Conclusions:

    • Prompt diagnosis and appropriate management are crucial for PVE.
    • Earlier surgical intervention is indicated in cases of heart failure, sepsis, fungal etiology, valve obstruction, heart block, or prosthesis instability.
    • While preventive measures exist, their impact on reducing the low incidence of PVE is likely minimal.