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Late prosthetic valve endocarditis. Bacteriological findings and prognosis in 29 cases
Abstract:
Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.
Insights
Late prosthetic valve endocarditis is a serious complication. Early valve replacement surgery may improve outcomes for patients with infectious endocarditis.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Late prosthetic valve endocarditis (PVE) is a significant complication following valve replacement surgery.
- This study examines PVE occurring more than two months after initial valve replacement.
Purpose of the Study:
- To analyze the clinical presentation, causative agents, and outcomes of late PVE.
- To identify factors associated with mortality in late PVE.
- To evaluate the impact of surgical intervention and antibiotic therapy on prognosis.
Main Methods:
- Retrospective analysis of 296 infectious endocarditis cases between 1971 and 1980.
- Identification of 29 cases of late PVE in 26 patients.
- Clinical data review, including causative microorganisms, clinical signs, and treatment strategies.
Main Results:
- Late PVE occurred in 10% of cases, with mitral, aortic, and multiple prostheses affected.
- Common clinical signs included fever, regurgitation murmur, splenomegaly, and neurologic events.
- Streptococci and staphylococci were the most frequent causative agents.
- The overall mortality rate was 58%, with higher rates linked to non-streptococcal infections, cardiac dysfunction, and neurologic complications.
- Surgical valve replacement, especially when delayed, was associated with a high mortality rate (75%).
Conclusions:
- Late PVE presents with diverse clinical manifestations and a high mortality rate.
- Prompt antibiotic therapy alone showed better outcomes than delayed surgery.
- Early and more frequent surgical intervention for PVE may be a viable strategy to improve patient prognosis.
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