title: Prosthetic valve endocarditis: management strategies and prognosis: A ten-year analysis in a tertiary care centre in Tunisia.
abstract: BACKGROUND
  Prosthetic valve endocarditis (PVE) is a rare and serious complication after heart valve replacement; its optimal management strategy, though, still needs to be defined.
  
  
  OBJECTIVE
  To study the clinical, microbiological and echocardiographic characteristics of PVE and to analyse the influence of the adopted therapeutic strategy (medical or surgical) on short- and midterm outcome in a tertiary care centre in a developing country (Tunisia).
  
  
  METHODS
  All cases of PVE treated in our institution between 1997 and 2006 were retrospectively analysed according to the modified DUKE criteria.
  
  
  RESULTS
  A total of 48 PVE episodes were diagnosed (30 men and 18 women), mean age was 37.93 years. Twenty-eight patients (58.33%) were exclusively medically treated, whereas 20 (41.66%) were treated by a combined surgical and medical strategy. Indications for surgery were haemodynamic deterioration in eight patients (40%), annular abscess in six (30%) and persisting sepsis in six (30%). In comparison with those from the medical group, operated patients had a longer delay to diagnosis (p=0.025), were more frequently in heart failure (p=0.04) and experienced more early complications (p=0.011); they also more frequently had prosthetic dehiscence (p=0.015), annular abscesses (p=0.039) and vegetations >10 mm (p=0.008). Conversely, no differences were found between the groups in terms of age, sex, or nature of involved organisms. In-hospital mortality for the medical group was 14.28% and for the surgical group 35% (p=0.09).
  
  
  CONCLUSIONS
  PVE is a very serious condition carrying high mortality rates regardless of the adopted strategy. Our study demonstrates that, in selected patients, medical treatment could be a successful and acceptable approach. (Neth Heart J 2009;17: 56-60.).
authors.affiliation: Department of Cardiology, University Hospital Hedi Chaker, Sfax, Tunisia.
authors.forename: S
authors.initials: S
authors.lastname: Rekik
authors.forename: I
authors.initials: I
authors.lastname: Trabelsi
authors.forename: A
authors.initials: A
authors.lastname: Znazen
authors.forename: I
authors.initials: I
authors.lastname: Maaloul
authors.forename: M
authors.initials: M
authors.lastname: Hentati
authors.forename: I
authors.initials: I
authors.lastname: Frikha
authors.forename: M
authors.initials: M
authors.lastname: Ben Jemaa
authors.forename: A
authors.initials: A
authors.lastname: Hammami
authors.forename: S
authors.initials: S
authors.lastname: Kammoun