Late prosthetic valve endocarditis: review of 19 cases and treatment.

Eighteen out of 1606 patients treated by valve replacement between January 1971 to June 1979 were admitted in Brugmann University Hospital for late prosthetic valve endocarditis. Of the 19 episodes (one patient had two distinct episodes four years apart), nine (group I) were treated medically and 10 (group II) by combined medical and surgical therapy. The infective organism was Staphylococcus epidermidis in two-thirds of our cases. Two cases in group I (22.2%) were long-term survivors. In group II, all 10 patients survived reoperation. There were four late deaths; six patients (60%) were still alive 1.8 to 4.4 years later (mean survival three years). Prompt prosthetic valve replacement is recommended in the presence of systemic emboli, evolving murmurs, uncontrolled sepsis or congestive heart failures (especially if the infective organism is a fungus or a staphylococcus), in late prosthetic valve endocarditis.