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The Annals of Thoracic Surgery, Vol 58, 1073-1077, Copyright © 1994 by The Society of Thoracic Surgeons
VL Yu, GD Fang, TF Keys, AA Harris, LO Gentry, PC Fuchs, MM Wagener and ES Wong
The objective of our study was to assess the long-term outcome of patients
with prosthetic valve endocarditis. We used a multicenter, prospective,
observational study design. Six university teaching hospitals with high
volume cardiothoracic surgery participated. Seventy- four patients with
prosthetic valve endocarditis as defined by explicit, objective criteria
were selected for participation. All patients were followed up
prospectively for 1 year. Thirty-one percent and 69% had development of
endocarditis within 60 days of valve insertion ("early") and after 60 days
("late"), respectively. The most common causes were Staphylococcus
epidermidis (40%), Staphylococcus aureus (20%), streptococcal species
(18%), and aerobic gram-negative bacilli (11%). Physical signs of
endocarditis (new or changing murmur, stigmata, emboli) were seen in 58%.
At 6 months and 12 months, mortality was 46% and 47%, respectively.
Surgical replacement of the infected valve led to significantly lower
mortality (23%) as compared with medical therapy alone (56%), as assessed
by both univariate and multivariate analyses (p < 0.05). Improved
outcome was seen for the surgical group even when controlling for severity
of illness at time of diagnosis. From these findings we conclude that
accurate assessment of outcome in prosthetic valve endocarditis requires
long-term follow-up of at least 6 months following diagnosis. Surgical
therapy warrants greater scrutiny; evaluation in controlled clinical trials
is appropriate.
ARTICLES
Prosthetic valve endocarditis: superiority of surgical valve replacement versus medical therapy only
Division of Infectious Diseases, University of Pittsburgh Medical Center, PA 15213.
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