SURGICAL AND LONG-TERM ANTIFUNGAL THERAPY FOR FUNGAL PROSTHETIC VALVEENDOCARDITIS

Background. Fungal prosthetic valve endocarditis is an uncommon but se rious disease. We have developed a strategy of treatment that includes perioperative amphotericin B, radical debridement of infected tissue, reconstruction using biologic tissue when possible, and prolonged ora l suppressive antifungal therapy. Methods. We retrospectively reviewed the charts of 12 patients reoperated on for fungal prosthetic valve e ndocarditis involving the aortic valve (10 patients: six porcine valve s, two mechanical valves, two homografts) and the mitral valve (2 pati ents, both porcine valves). Prosthetic valve endocarditis developed in 7 within 12 months after the first valve procedure, The organisms inc luded Candida species (9 patients), Scopulariopsis brevicaulis (1), Sa ccharomyces cervisiae (1), and histoplasmosis (1). Results. At operati on, all patients had prosthetic vegetations, 8 had abscesses, and 4 ha d sinus tracts. Seven received aortic homografts, 4 received porcine v alves (two mitral), and 1 received a mechanical prosthesis. Two patien ts died in the hospital after prolonged illnesses (83% hospital surviv al). Four patients had recurrence an average of 25 months later and 3 underwent further surgical intervention. One patient had recurrence an d died 17 months postoperatively. One other late death occurred 96 mon ths after operation, and there was no evidence of recurrence. Eight pa tients (67%) are alive and well 51.5 +/- 61.0 months (range, 1 to 189 months) after the first redo procedure for fungal prosthetic valve end ocarditis. Conclusions. We conclude that preoperative treatment with a mphotericin B, radical resection of all infected tissue, cardiac recon struction using biologic tissue when possible, and life-long oral anti fungal therapy is effective for fungal prosthetic valve endocarditis.