SURGICAL-TREATMENT OF PROSTHETIC VALVE ENDOCARDITIS

From 1975 through 1992, we reoperated on 146 patients for the treatmen t of prosthetic valve endocarditis, Prosthetic valve endocarditis was considered to be early (< 1 year after operation) in 46 cases and acti ve in 103 cases, The extent of the infection was prosthesis only in 66 patients, anulus in 46, and cardiac invasion in 34. Surgical techniqu es evolved in the direction of increasingly radical debridement of inf ected tissue and reconstruction,vith biologic materials, All patients were treated with prolonged postoperative antibiotic therapy, There we re 19 (13%) in-hospital deaths, Univariate analyses demonstrated trend s toward increasing risk for patients with active endocarditis and ext ension of infection beyond the prosthesis; however, the only variables with a significant (p < 0.05) association with increased in-hospital mortality confirmed with multivariate testing were impaired left ventr icular function, preoperative heart block, coronary artery disease, an d culture of organisms from the surgical specimen. During the study pe riod, mortality decreased from 20% (1975 to 1984) to 10% (1984 to 1992 ), For hospital survivors the mean length of stay was 25 days, Follow- up (mean interval 62 months) documented a late survival of 82% at 5 po stoperative Sears and 60% at 10 years, Older age was the only factor a ssociated (p = 0.006) with late death. Nineteen patients needed at lea st one further operation; reoperation-free survival was 75% at 5 and 5 0% at 10 postoperative years, Fever in the immediate preoperative peri od was the only factor associated with decreased late reoperation-free survival (p = 0.032). Prosthetic valve endocarditis remains a serious complication of valve replacement, but the in-hospital mortality of r eoperations for prosthetic valve endocarditis has declined. With exten sive debridement of infected tissue and postoperative antibiotic thera py, the extent and activity of prosthetic valve endocarditis does not appear to have a major impact on late outcome, and the majority of pat ients with this complication survive for 10 years after the operation.