[Prosthetic valve endocarditis: complication following cardiac surgery].
Prosthetic valve endocarditis (PVE) is a rare but serious complication following valve replacement surgery. Early-phase PVE, which occurs within 60 days of valve replacement, may be associated with nosocomial or intraoperative infection. The primary organism of this type is the Staphylococcus group. Late-phase PVE, which usually occurs more than one year after valve replacement, may be caused by a mechanism similar to that of native valve endocarditis. The primary causative organism of this type would thus be similar to that of native valve endocarditis, which is the Streptococcus group. To treat PVE effectively, it is extremely important to identify the primary causative organism. If uncontrollable cardiac failure or infection occurs, a second valve replacement is absolutely indicated. A cryopreserved aortic valve allograft, if available, is the first choice for PVE. Features such as cell viability, less compliance mismatch, and postantibiotic process could be reasons for the anti-infective characteristics of cryopreserved allografts. Currently, allograft valves are not widely available in Japan; therefore, conventional prosthetic valves are usually used. The use of antibiotic-soaked prosthetic valves or stentless xenograft valves has also been attempted. A genetic or tissue engineering approach could open a new era to overcome this lethal complication.
Motomura
Noboru
N
Department of Cardiac Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
Takamoto
Shinichi
S
D004697:Endocarditis, Bacterial / Q000209:etiology*; D006350:Heart Valve Prosthesis; D006801:Humans; D016459:Prosthesis-Related Infections; D013203:Staphylococcal Infections / Q000209:etiology