S. Bertrand et al., Preliminary experience with Silzone (TM)-coated St. Jude medical valves inacute infective endocarditis, J HEART V D, 9(1), 2000, pp. 131-134
Background and aim of the study: The rate of recurrent postoperative endoca
rditis after valve replacement in early-stage acute infective endocarditis
is extremely high. Metallic silver coating of the sewing ring may improve t
he short- and long-term outcome after valve implantation. This report detai
ls our experience with the St. Jude Medical SilzoneTM prosthesis in early s
urgical treatment of acute infective endocarditis.
Methods: Ten patients (mean age 66.4 years) referred for native valve or pr
osthetic valve endocarditis were operated on between April 1998 and June 19
99. The microorganisms responsible for the acute infection were Staphylococ
cus (n = 1), Streptococcus (n = 1) and Pseudomonas aeruginosa (n = 1); bloo
d cultures remained negative in two cases. The indication for surgical trea
tment was related to hemodynamic condition (n = 5), a major cerebral event
(stroke; n = 1), annulus abscess (n = 1), and echocardiographic evidence of
large cuspal vegetations (n = 3). All patients had received preoperative i
ntravenous antibiotics (mean 7.8 days). Four mitral, five aortic valve repl
acements, and one double mitral-aortic valve replacement, were performed af
ter extensive debridement of the infected and necrotic tissues. Mean durati
on of postoperative antibiotic treatment was 32.3 days. Postoperative follo
w up (mean 6 months; range: 2-14.2 months) was 100% complete, and included
prospective repeated transthoracic echocardiography at one week, and one, s
ix and 12 months postoperatively.
Results: One patient died early in the immediate postoperative period from
pneumonia and major hypoxemia. All other patients are symptom-free, without
evidence of recurrent infection and perivalvular leak.
Conclusion: Although these early results with the St. Jude Medical Silzone
prosthesis require confirmation by more extensive studies, they infer that
silver coating of the sewing ring may dramatically improve management of pa
tients with active endocarditis.