title: Management of prosthetic valve infective endocarditis.
abstract: This study analyzed the profile and outcome of surgically versus medically treated patients with prosthetic valve infective endocarditis (PVE). From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated group was separated into deliberately conservative and perforce conservative treatments, the latter group including patients with contraindications to a cardiosurgical intervention. The most frequent causative micro-organisms were staphylococci. Forty-six percent of patients were surgically treated, 34% had deliberately conservative treatment, and 20% had perforce conservative treatment. Six-month mortality was 29%; 27% of surgically treated patients died, 4% deliberately conservatively patients died, and 75% perforce conservatively treated patients died. Septic shock, multiorgan failure, and type of treatment were significantly associated with death in univariable analysis. Multivariable analysis revealed that type of treatment (perforce conservative) and septic shock predicted death in patients with PVE. Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus. In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment.
authors.affiliation: Department of Internal Medicine-Infectious Diseases, K.U. Leuven, University Hospital Gasthuisberg, Leuven, Belgium. evelyn.hill@uz.kuleuven.be
authors.forename: Evelyn E
authors.initials: EE
authors.lastname: Hill
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Herregods
authors.forename: Steven
authors.initials: S
authors.lastname: Vanderschueren
authors.forename: Piet
authors.initials: P
authors.lastname: Claus
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
mesh_terms: D000368:Aged; D004697:Endocarditis, Bacterial / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D006350:Heart Valve Prosthesis / Q000382:microbiology*; D006351:Heart Valves / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000401:mortality; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D012772:Shock, Septic / Q000401:mortality