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Ann Thorac Surg 1987;43:450-457
© 1987 The Society of Thoracic Surgeons

Articles

A Practical Approach to Prosthetic Valve Endocarditis

L. Douglas Cowgill, M.D.*, V. Paul Addonizio, M.D., Alan R. Hopeman, M.D., Alden H. Harken, M.D.

Departments of Surgery, University of Colorado, Denver, CO, and University of Pennsylvania, Philadelphia, PA

* Address reprint requests to Dr. Cowgill, Marshfield Clinic, 1000 North Oak Ave, Marshfield, WI 54449

Prosthetic valve endocarditis (PVE) is an infrequent but dread complication, occurring in 1 to 2% of patients both early (less than 60 days) and late postoperatively. Diagnosis is always (99%) possible by two sets of blood cultures, but occasional exogenous causes of bacteremia may cloud the diagnosis, as will culture-negative cases of PVE and skin contaminants. With obvious exogenous sources of bacteremia, achieving sterile blood cultures after eradication of the noncardiac source permits discontinuation of antibiotics after two weeks. When skin contaminants are suspected, withholding antibiotics and obtaining two sets of blood cultures is recommended, because the bacteremia with PVE is continuous.

Preventive measures, including perioperative antibiotics, are warranted but will probably not significantly reduce the low incidence of infection already achieved. The major cause of improved survival in recent years is earlier operation (valve rereplacement). This has been demonstrated in the last ten years and is absolutely indicated for major heart failure, ongoing sepsis, fungous etiology, valve obstruction, new-onset heart block, and unstable prosthesis by fluoroscopy.




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