Prosthetic Valve Endocarditis: Importance of Surgical Treatment

Abstract

Surgical therapy of prosthetic valve endocarditis (PVE) is still associated with a high mortality of up to 80 %. Further risk analysis and characterization of clinical features are important for a further improvement of surgical results. The aim of this retrospective study was a risk analysis of clinical features of the pre-, intra-, and postoperative period. Between February 1998 and December 2004, 70 patients (52 male, 18 female, age 62 ± 11 years) were referred to our institution for surgical therapy of PVE. This cohort included 16 patients with early PVE and 54 patients with late PVE. Preoperative, intraoperative and postoperative features were evaluated with respect to their influence on the early postoperative course and the midterm follow-up. The aortic valve was affected in 41 patients (58.6 %) and the mitral valve in 15 patients (21.4 %). Double valve infection was recorded in 14 patients (20.0 %). Staphylococci (n = 36, 51.4 %), Streptoccoci (n = 9, 12.9 %) and others (n = 24, 14.5 %) were identified as causative agents in blood cultures. The hospital mortality rate was 20.0 % (n = 14), during follow-up (mean follow up: 3.3 ± 2.5 years), a further 11 patients (15.7 %) died, resulting in an overall mortality of 35.7 %. The main predictors for hospital mortality were preoperative heart failure (p = 0.01) and Staphylococci infection (p = 0.01). Predictors of overall mortality were Staphylococci infection (p = 0.01), heart failure (p = 0.02) and abscess formation (p = 0.02). Surgical therapy of prosthetic valve endocarditis is still associated with quite a high mortality during the early and midterm follow-up. Predictors of outcome particularly include preoperative risk constellations (heart failure, Staphylococci infection).

cardiovascular surgery - heart valve surgery - heart disease - endocarditis

References

• 1 Balakrishnan M, Gianni A, Massimo C, Jin X Y, Bryan A. Prosthetic valve endocarditis.  Ann Thorac Surg. 2005;  80 1151-1158
• 2 Vongpatanasin W, Hillis L D, Lange R A. Prosthetic heart valves.  N Engl J Med. 1996;  335 407-416
• 3 Akowuah E F, Davies W, Oliver S. et al . Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment.  Heart. 2003;  89 269-272
• 4 Piper C, Körfer R, Horstkotte D. Prosthetic valve endocarditis.  Heart. 2001;  85 590-593
• 5 Strandbridge T N, Isalska B J. Aspects of prosthetic valve endocarditis.  J Infect. 1997;  35 1-6
• 6 Task force on infective endocarditis of the European Society of Cardiology . Guidelines on prevention, diagnosis and treatment of infective endocarditis.  Eur Heart J. 2004;  1-37
• 7 Calderwood S B, Swinski L A, Karchmer A W. et al . Prosthetic valve endocarditis: analysis of factors affecting outcome of the therapy.  J Thorac Cardiovasc Surg. 1986;  92 776-783
• 8 Habib G, Tribouilloy C, Thuny F. et al . Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases.  Heart. 2005;  91 954-959
• 9 Alexiou C, Langley S M, Stafford H. et al . Surgery for active culture-positive endocarditis: determinants of early and late outcome.  Ann Thorac Surg. 2000;  69 1448-1454
• 10 Grünenfelder J, Akins C W, Hilgenberg A D. et al . Long-term results and determinants of mortality after surgery for native and prosthetic valve endocarditis.  J Heart Valve Dis. 2001;  10 694-702
• 11 Mihaljevic T, Byrne J G, Cohn L H. et al . Long-term results of multivalve surgery for infective multivalve endocarditis.  Eur J Cardiothorac Surg. 2001;  20 842-846
• 12 Bonow R O, Carabello B, de Leon Jr A C. et al . Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  Circul. 1998;  98 1949-1984
• 13 Delay D, Pellerin M, Carrier M. et al . Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis.  Ann Thorac Surg. 2000;  70 1219-1223
• 14 Fowler V G, Sexton D J. The role of valve replacement in the treatment of prosthetic valve endocarditis.  Clin Infect Dis. 1998;  26 1310-1311
• 15 Piehler J, Blackstone E H, Bailey K R. et al . Reoperation on prosthetic heart valves: patient specific estimates of in-hospital events.  J Thorac Cardiovasc Surg. 1995;  109 30-48
• 16 Yu V L, Fang G D, Keys T F. et al . Prosthetic valve endocarditis: superiority of surgical valve replacement versus medical therapy only.  Ann Thorac Surg. 1994;  58 1073-1077
• 17 Romano G, Carozza A, Della Corte A. et al . Native versus primary prosthetic valve endocarditis: comparison of clinical features and long-term outcome in 353 patients.  J Heart Valve Dis. 2004;  13 200-209
• 18 Renzulli A, Carozza A, Romano G P. et al . Recurrent infective endocarditis: a multivariate analysis of 21 years of experience.  Ann Thorac Surg. 2001;  72 39-43
• 19 Tornos P, Almirante B, Olona M. et al . Clinical outcome and long-term prognosis of late prosthetic valve endocarditis: a 20-year experience.  Clin Infect Dis. 1997;  24 381-386
• 20 Vlessis A A, Hovaguimian H, Jaggers J. et al . Infective endocarditis: ten year review of medical and surgical therapy.  Ann Thorac. 1996;  111 198-210
• 21 Gordon S M, Serkey J M, Longworth D L. et al . Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992 - 1997.  Ann Thorac Surg. 2000;  69 1388-1392