Cowgill L D, Addonizio V P, Hopeman A R, Harken A H
Ann Thorac Surg. 1987 Apr;43(4):450-7. doi: 10.1016/s0003-4975(10)62835-4.
Prosthetic valve endocarditis (PVE) is an infrequent but dread complication, occurring in 1 to 2% of patients both early (less than 60 days) and late postoperatively. Diagnosis is always (99%) possible by two sets of blood cultures, but occasional exogenous causes of bacteremia may cloud the diagnosis, as will culture-negative cases of PVE and skin contaminants. With obvious exogenous sources of bacteremia, achieving sterile blood cultures after eradication of the noncardiac source permits discontinuation of antibiotics after two weeks. When skin contaminants are suspected, withholding antibiotics and obtaining two sets of blood cultures is recommended, because the bacteremia with PVE is continuous. Preventive measures, including perioperative antibiotics, are warranted but will probably not significantly reduce the low incidence of infection already achieved. The major cause of improved survival in recent years is earlier operation (valve rereplacement). This has been demonstrated in the last ten years and is absolutely indicated for major heart failure, ongoing sepsis, fungous etiology, valve obstruction, new-onset heart block, and unstable prosthesis by fluoroscopy.
人工瓣膜心内膜炎（PVE）是一种罕见但可怕的并发症，在术后早期（少于60天）和晚期的患者中发生率为1%至2%。通过两组血培养，诊断通常（99%）是可行的，但偶尔的外源性菌血症病因可能会使诊断变得模糊，PVE的血培养阴性病例和皮肤污染物也会如此。对于有明显外源性菌血症来源的情况，在根除非心脏来源后实现血培养无菌，可在两周后停用抗生素。当怀疑有皮肤污染物时，建议暂停使用抗生素并进行两组血培养，因为PVE导致的菌血症是持续性的。包括围手术期抗生素在内的预防措施是必要的，但可能不会显著降低已达到的低感染发生率。近年来生存率提高的主要原因是更早进行手术（瓣膜再次置换）。这在过去十年中已得到证实，对于严重心力衰竭、持续性脓毒症、真菌病因、瓣膜梗阻、新发心脏传导阻滞以及透视显示假体不稳定的情况，绝对需要进行手术。
