CLINICAL OUTCOME AND LONG-TERM PROGNOSIS OF LATE PROSTHETIC VALVE ENDOCARDITIS - A 20-YEAR EXPERIENCE

A prospective study of the clinical characteristics and evolutionary p atterns of 59 cases of late prosthetic valve endocarditis (LPVE) that occurred between January 1975 and December 1994 was performed. Of thes e 59 cases of LPVE, 48 involved mechanical valves and 11 involved biol ogical valves. Etiologies were as follows: streptococci, 41% of cases; staphylococci, 25%; enterococci, 13%; and miscellaneous, 21%. Echocar diography documented vegetations in 21 patients, paravalvular abscesse s in 10, and prosthetic leaks in 34. Emboli occurred in 22 patients, a nd heart failure in 19 patients. Forty-two patients received medical t reatment alone, and 17 received medical treatment and underwent valve replacement surgery. The in-hospital mortality rate was 25%; staphyloc occal infection caused 67% of deaths, streptococcal infection caused 5 %, and other etiologies caused 23% (P = .0004). After adjustment for a ge and type of prosthesis, multiple logistic regression revealed an od ds ratio for death due to nonstreptococcal infections of 9.67, The ove rall survival rate was 59% at 5 years and 52% at 10 years. During foll ow-up, 17 patients needed new valves. At the end of follow-up, only 13 patients remained alive and had the same prosthesis that they had at the time of the diagnosis of LPVE.