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Fungal prosthetic valve endocarditis
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
Seminars in Thoracic and Cardiovascular Surgery
|January 1, 1995
Summary
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.