Recurrent endocarditis in silver-coated heart valve prosthesis

Background and aim of the study: In order to prevent prosthetic valve endoc arditis (PVE), the implantation of a new silver-coated sewing ring has been introduced to provide peri- and postoperative protection against microbial infection. Methods: A 56-year-old woman with aortic stenosis had elective replacement with a St. Jude Medical(R) mechanical valve fitted with a silver-coated sew ing ring (Silzone(TM)). The patient developed early PVE, which necessitated reoperation after one month. Despite a second Silzone prosthesis being imp lanted, the endocarditis recurred. During a third operation an aortic homog raft was implanted, and after six months a fourth operation was performed f or a pseudoaneurysm at the base of the homograft, in proximity to the anter ior mitral valve leaflet. Results: The diagnosis of PVE was confirmed by the presence of continuous f ever, transesophageal echocardiography and growth of penicillin-resistant S taphylococcus epidermidis from the valve prosthesis. Conclusion: The implantation of all prosthetic valves is encumbered with a risk of endocarditis. Although silver has bacteriostatic actions, the advan tages of silver-coated prostheses in the treatment of this condition have y et to be assessed in clinical trials.