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Fungal prosthetic valve endocarditis
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
Abstract:
Fungal prosthetic valve endocarditis is an unusual cause of endocarditis, yet very important because of its historical poor prognosis. This article will review the incidence, presentation, diagnosis, and treatment results of fungal prosthetic valve endocarditis. In addition, 11 patients at The Cleveland Clinic over the last 16 years were treated with a strategy consisting of aggressive perioperative amphotericin B therapy, radical surgical debridement of all infected tissue and prosthetic valve replacement with biological tissue when possible, as well as the chronic use of oral azole antifungal agents for suppression. This combined approach has resulted in 82% of patients being discharged and a 55% 5-year survival rate. Unfortunately, 36% of patients developed recurrent fungal prosthetic valve endocarditis, at an average of 25.8 months after their first operation for fungal prosthetic valve endocarditis. The use of oral antiazole antifungal agents for suppression may prevent the high incidence of recurrent endocarditis in this patient population.
Insights
Fungal prosthetic valve endocarditis (FPVE) is rare but serious. A combined treatment of surgery, aggressive antifungal drugs, and long-term oral azoles improved survival but recurrence remains a concern.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Fungal prosthetic valve endocarditis (FPVE) is an uncommon but severe condition with historically poor outcomes.
- Effective management strategies for FPVE are crucial due to its high mortality and morbidity.
Purpose of the Study:
- To review the incidence, presentation, diagnosis, and treatment outcomes of FPVE.
- To evaluate a specific treatment protocol for FPVE at The Cleveland Clinic.
Main Methods:
- Retrospective review of 11 patients treated over 16 years.
- Treatment involved aggressive perioperative amphotericin B, radical surgical debridement, prosthetic valve replacement (preferably biological), and chronic oral azole suppression.
Main Results:
- The combined approach resulted in an 82% discharge rate and a 55% 5-year survival rate.
- Despite treatment, 36% of patients experienced recurrent FPVE at an average of 25.8 months post-operation.
Conclusions:
- Aggressive surgical and antifungal treatment improves outcomes for FPVE.
- Chronic oral azole suppression may be key to preventing high rates of recurrent FPVE.