title: Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment.
abstract: OBJECTIVE
  To compare the early and late outcome of medical and surgical treatment in patients with prosthetic valve endocarditis within a single unit.
  
  
  METHODS
  All patients with proven prosthetic valve endocarditis treated in one institution between 1989 and 1999 were studied.
  
  
  RESULTS
  There were 66 patients (24 female, 42 male), mean (SD) age 57 (14) years. Of these, 28 were treated with antibiotics alone and 38 with a combination of antibiotics and surgery. The in-hospital mortality for the antibiotic group was 46% and for the surgical group, 24%. However, seven patients in the antibiotic group were considered too sick for curative treatment. The mortality in the remaining 21 medically treated patients (6/21; 29%) was not significantly different from that in the surgically treated patients (p = 0.15). Six patients in the medically treated group and one in the surgically treated group required late reoperation. Endocarditis recurred in three patients in the medically treated group, two of whom were treated surgically, and in one patient in the surgically treated group. Kaplan-Meier survival at 10 years was 28% in the medically treated group v 58% in the surgically treated group (p = 0.04). Freedom from endocarditis at five years was 60% in the surgically treated group and 65% in the medically treated group.
  
  
  CONCLUSIONS
  Prosthetic valve endocarditis is a serious condition with high early and late mortality, irrespective of the treatment employed. These data show that selected patients with prosthetic valve endocarditis can be successfully treated with antibiotics alone. If required, surgery in this difficult group of patients can provide satisfactory freedom from recurrent infection.
authors.affiliation: Department of Cardiothoracic Surgery, Northern General Hospital, Herries Road, Sheffield, UK.
authors.forename: E F
authors.initials: EF
authors.lastname: Akowuah
authors.forename: W
authors.initials: W
authors.lastname: Davies
authors.forename: S
authors.initials: S
authors.lastname: Oliver
authors.forename: J
authors.initials: J
authors.lastname: Stephens
authors.forename: I
authors.initials: I
authors.lastname: Riaz
authors.forename: P
authors.initials: P
authors.lastname: Zadik
authors.forename: G
authors.initials: G
authors.lastname: Cooper
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004697:Endocarditis, Bacterial / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy* / Q000601:surgery*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents