Preliminary experience with Silzone (TM)-coated St. Jude medical valves inacute infective endocarditis

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.