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Late prosthetic valve endocarditis: review of 19 cases and treatment

T Prigogine, Y Goffin, F Deuvaert

    European Heart Journal
    |March 1, 1983
    PubMed

    Insights

    Combined medical and surgical therapy significantly improves survival rates for patients with late prosthetic valve endocarditis, particularly those with Staphylococcus epidermidis infections.

    Area of Science:

    • Cardiology
    • Infectious Diseases
    • Surgical Innovation

    Background:

    • Late prosthetic valve endocarditis (PVE) is a serious complication following valve replacement surgery.
    • Staphylococcus epidermidis is a frequent causative agent in PVE.
    • Outcomes for PVE have historically been challenging.

    Purpose of the Study:

    • To evaluate the efficacy of different treatment strategies for late prosthetic valve endocarditis.
    • To compare medical management versus combined medical and surgical therapy for PVE.
    • To identify predictors of survival in patients with PVE.

    Main Methods:

    • Retrospective analysis of 19 episodes of late PVE in 18 patients treated between 1971 and 1979.
    • Patients were divided into two groups: medical therapy (Group I) and combined medical-surgical therapy (Group II).
    • Causative organisms and patient outcomes, including survival rates, were analyzed.

    Main Results:

    • Staphylococcus epidermidis was identified in two-thirds of cases.
    • Medical therapy alone resulted in a 22.2% long-term survival rate.
    • Combined medical and surgical therapy led to a 100% survival rate post-reoperation, with 60% alive at a mean of three years.

    Conclusions:

    • Combined medical and surgical therapy offers superior outcomes for late prosthetic valve endocarditis.
    • Prompt surgical intervention is crucial in cases of PVE with systemic emboli, evolving murmurs, uncontrolled sepsis, or heart failure.
    • Aggressive treatment is especially vital when fungal or staphylococcal infections are implicated.

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