Prosthetic valve endocarditis: Superiority of surgical valve replacement versus medical therapy only

doi:10.1016/0003-4975(94)90458-8

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Prosthetic valve endocarditis: Superiority of surgical valve replacement versus medical therapy only

Victor L. Yu, MD^_*^,a^,b^,c^,d^,e^,f, Guodong D. Fang, MD^a^,b^,c^,d^,e^,f, Thomas F. Keys, MD^a^,b^,c^,d^,e^,f, Alan A. Harris, MD^a^,b^,c^,d^,e^,f, Layne O. Gentry, MD^a^,b^,c^,d^,e^,f, Peter C. Fuchs, MD^a^,b^,c^,d^,e^,f, Marilyn M. Wagener, MPH^a^,b^,c^,d^,e^,f, Edward S. Wong, MD^a^,b^,c^,d^,e^,f

^a University of Pittsburgh and VA Medical Center, Pittsburgh, Pennsylvania, USA
^b The Cleveland Clinic, Cleveland, Ohio, USA
^c Baylor University, Houston, Texas, USA
^d Rush Presbyterian-St Luke's Medical Center, Chicago, Illinois, USA
^e St. Vincent Hospital and Medical Center, Portland, Oregon, USA
^f Hunter-McGuire VA Medical Center, Richmond, Virginia, USA

Accepted for publication February 18, 1994.

^_* Address reprint requests to Dr Yu. Division of Infectous Disease University of Pittsburgh Medical Center, manhetione W-93I. Pittsburgh, PA 15213.

The objective of our study was to assess the long-term outcomeof patients with prosthetic valve endocarditis. We used a multicenter,prospective, observational study design. Six university teachinghospitals with high volume cardiothoracic surgery participated.Seventy-four patients with prosthetic valve endocarditis asdefined by explicit, objective criteria were selected for participation.All patients were followed up prospectively for 1 year. Thirty-onepercent and 69% had development of endocarditis within 60 daysof valve insertion ("early") and after 60 days ("late"), respectively.The most common causes were Staphylococcus epidermidis (40%),Staphylococcus aureus (20%), streptococcal species (18%), andaerobic gram-negative bacilli (11%). Physical signs of endocarditis(new or changing murmur, stigmata, emboli) were seen in 58%.At 6 months and 12 months, mortality was 46% and 47%, respectively.Surgical replacement of the infected valve led to significantlylower mortality (23%) as compared with medical therapy alone(56%), as assessed by both univariate and multivariate analyses(p < 0.05). Improved outcome was seen for the surgical groupeven when controlling for severity of illness at time of diagnosis.From these findings we conclude that accurate assessment ofoutcome in prosthetic valve endocarditis requires long-termfollow-up of at least 6 months following diagnosis. Surgicaltherapy warrants greater scrutiny; evaluation in controlledclinical trials is appropriate.

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