[Treatment outcome of prosthetic valve endocarditis].

BACKGROUND AND AIMS OF THE STUDY

Prosthetic valve endocarditis (PVE) occurred from 1 to 9% of patient after heart valve replacement. The aim of the present study was to assess the long term outcome of the treatment of PVE and to analyze the recurrence of infective endocarditis (IE).

MATERIAL

Hospital mortality, recurrence and late survival were analyzed in 59 patients hospitalized in the Institute of Cardiology for PVE between 1988-95. There were 26 females and 33 males with age ranging from 17 to 71 years (mean 48). The onset of PVE was within 60 days from valve replacement in 17 patients and therefore it was considered as early PVE, in 42 patients PVE occurred beyond 60 days from valve replacement was considered as late.

METHODS

The criteria of Durack et al. were applied to diagnose PVE. Each patient was classified as having definite PVE, possible PVE, or rejected PVE. The late examinations were performed out-patient in Ist Department of Valvular Heart Disease of Institute of Cardiology.

RESULTS

Prosthetic valve replacement in addition to medical treatment was preferred for 34 (58%) of the 59 cases (8 death), whereas 25 (42%) cases were only managed medically (5 death). The overall hospital mortality rate was 22% (13 patients). There were 8 (17%) episodes of recurrence with mean interval of 6 months between both episodes. 6 patients were cured, 2 died. Staphylococcal epidermidis infection was present in 63%. Recurrence of IE due to the same microorganism was in 88% of episodes. During follow up (mean 4 years) 5 late deaths occurred. Actual 4 years survival was 69%.

CONCLUSIONS

1. Mean survival after 4 years was 69%, 2. Total mortality was 31%, 22% hospital, 9% in late observation (decreased from 8% in first 2 years to 1% mean 4 years after cure, 3. Recurrence of IE was observed in 17% of episodes, most cases (88%) were caused by the same bacteria as in the primary infection.