PROSTHETIC VALVE ENDOCARDITIS - CASE FOR PROMPT VALVE-REPLACEMENT

Abstract

Treatment of patients with prosthetic valve endocarditis with existing guidelines failed to reduce the over-all mortality rate to below 50%. Subgroups with high or lower risk of death could be delineated on the basis of risk factors, e.g., early onset following surgery, high-risk causative organisms, cardiodynamic failure and septic emboli. High-risk patients comprise > 70% of those with prosthetic valve endocarditis in recent series. Analysis of previously reported series indicated that the mortality rate for high-risk patients with late onset of prosthetic valve endocarditis treated by valve replacement was less than that of patients receiving only medical therapy. Six consecutive patients with prosthetic valve endocarditis (3 early onset, 3 late onset) were treated by valve replacement before completion of a course of antibiotics. All patients survived surgery but 1 patient died after 4 1/2 mo. of noninfectious causes. Prompt valve replacement is technically feasible and should become the standard therapy for patients with prosthetic valve endocarditis who do not fall into the lower risk group.