Prosthetic valve endocarditis: Importance of surgical treatment

Surgical therapy of prosthetic valve endocarditis (PVE) is still associated with a high mortality of up to 80%. Further risk analysis and characterization of clinical features are important for a further improvement of surgical results. The aim of this retrospective study was a risk analysis of clinical features of the pre-, intra-, and postoperative period. Between February 1998 and December 2004, 70 patients (52 male, 18 female, age 62 +/- 11 years) were referred to our institution for surgical therapy of PVE. This cohort included 16 patients with early PVE and 54 patients with late PVE. Preoperative, intra-operative and postoperative features were evaluated with respect to their influence on the early postoperative course and the midterm follow-up. The aortic valve was affected in 41 patients (58.6%) and the mitral valve in 15 patients (21.4%). Double valve infection was recorded in 14 patients (20.0%). Staphylococci (n = 36, 51.4%), Streptoccoci (n = 9, 12.9%) and others (n = 24, 14.5%) were identified as causative agents in blood cultures. The hospital mortality rate was 20.0% (n = 14), during follow-up (mean follow up: 3.3 +/- 2.5 years), a further 11 patients (15.7%) died, resulting in an overall mortality of 35.7%. The main predictors for hospital mortality were preoperative heart failure (p = 0.01) and Staphylococci infection (p = 0.01). Predictors of overall mortality were Staphylococci infection (p = 0.01), heart failure (p = 0.02) and abscess formation (p = 0.02). Surgical therapy of prosthetic valve endocarditis is still associated with quite a high mortality during the early and midterm follow-up. Predictors of outcome particularly include preoperative risk constellations (heart failure, Staphylococci infection).