Valvular heart diseaseManagement of Prosthetic Valve Infective Endocarditis
Section snippets
Methods
From June 2000 to June 2006, 80 patients >16 years of age were consecutively included if they met the modified Duke criteria for definite PVE.1 PVE included not only patients with mechanical prosthesis but also those with bioprosthetic valves. Patients underwent cardiac surgery according to predefined criteria for surgical intervention.2 All patients were treated according to the American Heart Association guidelines3 and were seen by the cardiologist, cardiac surgeon, and infectious diseases
Results
The man/woman ratio was 2.5/2. Thirty-nine percent of cases were of nosocomial origin. The most frequent type of prosthetic valve was mechanical (61%). Epidemiologic characteristics and presence of underlying conditions are presented in Table 1.
Biological prosthetic valves were significantly associated with early PVE, in particular 48% (13 of 27) of PVEs on biological valves included early PVE versus 16% (6 of 49) of PVEs on mechanical valves (p = 0.001); Two patients had early PVE on
Discussion
The present study is the first to analyze outcome in surgically versus deliberately conservatively treated PVE patients. This study suggests that there remains a role for watchful waiting after diagnosis and institution of antibiotics in patients with PVE and no evidence of major complications. Moreover, our findings support that patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. In our series, almost ½ of patients underwent cardiac surgery, mainly
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Cited by (60)
Commentary: Greater risk of infective endocarditis after biologic valve replacement: A word of caution before expanding the indications to younger patients
2023, Journal of Thoracic and Cardiovascular SurgeryInfective Endocarditis Caused by Staphylococcus aureus After Transcatheter Aortic Valve Replacement
2022, Canadian Journal of CardiologyLong-term follow-up of patients with infective endocarditis in a tertiary referral center
2021, International Journal of CardiologyA fatal case of early prosthetic valve endocarditis caused by multidrug-resistant (MDR) – Sphingomonas paucimobilis
2021, IDCasesCitation Excerpt :If left untreated without surgical intervention, the mortality rate of paravalvular infection is expected to be 100 % [2,21]. Nevertheless, the risk of surgery in PVE with perivalvular extension is also high; prior studies have shown the operative mortality rates of 10–30 % with experienced cardiac surgeons [21]. Finally, in this case, we conclude that MDR - S. paucimobilis could cause early PVE, particularly in the immunocompromised patient.
Pseudomonas MitraClip® endocarditis: A case report and review of literature
2020, IDCasesCitation Excerpt :What arises in these scarce situations is a dilemma involving surgical management. When examining all cases of prosthetic valve endocarditis, around 40–50 % are managed with the addition of surgical intervention [8,9]. The evidence behind this practice is limited to observational and cohort studies [10].