Short and long-term prognosis of prosthetic valve endocarditis in non-addicts

Introduction and objectives. Prosthetic valve infective endocarditis is a c omplication of valvular replacement surgery with a high morbimortality duri ng the in-hospital phase and an important risk of complications during foll owup. The objective of the present study is to assess the clinical features and the short and long-term prognosis of this disease. Patients and methods. A prospective study of 43 consecutive cases of prosth etic valve endocarditis in non-addict patients from January 1987 to March 1 997. Results. The mean age was 51 +/- 16 years. Eight patients (19%) had early p rosthetic valve endocarditis (two months following heart surgery), fourteen patients (32%) had intermediate (between 2 and 12 months post surgery) and twenty-one (49%) had late prosthetic valve endocarditis (more than one yea r after heart surgery). Transesophageal echocardiography was performed in 3 2 patients with a sensibility of 81%. Complications occurred in 86% of pati ents and 53% of patients underwent surgery during the active phase (25% was emergency surgery). Inpatient mortality was 23% (50% in early prosthetic v alve endocarditis). After a mean follow-up of 56 months there were 5 cases of recurrence, four patients required late surgery and 5 patients died. Sur vival (excluding early mortality) was 82% at 5 years with no significant di fferences among patients who received only medical treatment and those who underwent surgery in the active phase. Conclusions. Early mortality of prosthetic valve endocarditis is, according to our experience of 20%. The prognosis of survivors to the active phase i s favourable in the majority. Early prosthetic valve endocarditis still cau ses a high mortality rate despite the use of combined medical-surgical trea tment in most cases.