PROGNOSTIC FACTORS OF PROSTHETIC VALVE EN DOCARDITIS - RESULTS IN A SERIES OF 122 CASES

The prognostic factors of 122 patients suffering from prosthetic valve endocarditis between 1978 and 1992 were studied by univariate and mul tivariate analysis. The principal causative organisms were Staphylococ cus aureus (33%), streptococci (20%); coagular-negative staphylocci (1 2%), enterococci (10%) and gram-negative bacilli (9%). The 4 month sur vival rate was 66% (42 deaths). The main predictive factor for death w as infection with S. aureus (75% vs 15% with other organisms). In S. a ureus infection, multivariate analysis identified the following predic tive factors for death : a prothrombin ratio less than 30% (RR = 8.3), mediastinitis (RR = 4.9), cardiac failure (RR = 4.4) and septic shock (RR = 2.6). In cases of infection with other organisms, the following factors were predictive of death : a prothrombin ratio of less than 3 0% (RR = 32.26), renal failure (RR = 7.31) and cardiac failure (RR = 6 .07). In patients with S. aureus infection, survival was better after than without surgery : 9/20 (45%) versus 0/20 (p < 0.001). In infectio n with other organisms, there was no difference in a survival after su rgical (89%) or medical therapy (81%). Chronic endocarditis relapses o ver 1 to 5 years was observed in 9 cases. All patients were reoperated a total number of 18 times with 5 deaths. Very prolonged antibiotic t herapy is recommended in these patients. The authors conclude that end ocarditis not due to S. aureus and without complications may be treate d medically. Rapid reoperation is necessary in all other cases.