The surgical treatment of patients with prosthetic valve endocarditis

Prosthetic valve endocarditis is associated with high mortality and morbidity. Although antibiotics alone may sterilize an infected prosthetic valve, adjunctive surgical therapy is often necessary. Depending on the virulence of the offending microorganism, the type of prosthetic valve and the site where it was implanted, the infection spreads into paravalvular structures, producing abscess. Systemic embolization of infected material may cause metastatic abscess. Thus, timing of surgery in these patients is crucial to optimize clinical results. An aggressive approach is justifiable in most patients with prosthetic valve endocarditis. It is believed that radical resection of all infected material and reconstruction of the heart and annuli with fresh autologous or glutaraldehyde-fixed bovine pericardium offer the best chance to eradicate the infection. Prolonged antibiotic therapy is also necessary in these patients. In the author's personal experience with 45 patients with prosthetic valve endocarditis, the infection was limited to the valve in 10 patients and had extended into the surrounding tissues in 35. The operative mortality rate was 13%. The actuarial survival at 5 years was 61% +/- 5%. These results support the premise that radical resection of all infected materials offers a good chance for curing prosthetic valve endocarditis.