The management of prosthetic valve endocarditis

During the period 1970 to 1980 2,945 patients underwent valve replacement at the Brompton Hospital. Thirty-one (1%) patients subsequently developed prosthetic valve endocarditis (P.V.E.). Twenty-one (0.7%) patients developed endocarditis within two months of valve replacement. Ten patients were treated medically, with seven deaths, whilst four of the eleven surgical cases died. There were ten cases of late P.V.E. occurring between two months and eight years after initial valve replacement (0.12% per annum). Eight patients were treated surgically, with two deaths, whilst both medical cases died. Thus 67% patients were effectively treated by immediate valve replacement, whilst only 25% medical cases survived. Actuarial survival curves predict a 41% five-year survival following surgery for P.V.E. We stress the importance of early diagnosis of this condition and recommend immediate valve replacement in all patients with P.V.E. developing signs of haemodynamic failure.