Long term results of mechanical prostheses for treatment of active infective endocarditis

Abstract

Objective-To analyse the long term results of mechanical prostheses for treating active infective endocarditis. Design-Prospective cohort study of a consecutive series of patients diagnosed with infective endocarditis and operated on in the active phase of the infection for insertion of a mechanical prosthesis. Setting-Tertiary referral centre in a metropolitan area. Results-Between 1975 and 1997, 637 cases of infective endocarditis were diagnosed in the centre. Of these, 436 were left sided (with overall mortality of 20.3%). Surgical treatment in the active phase of the infection was needed in 141 patients (72% native, 28% prosthetic infective endocarditis). Mechanical prostheses were used in 131 patients. Operative mortality was 30.5% (40 patients). Ninety one survivors were followed up prospectively for (mean (SD)) 5.4 (4.5) years. Thirteen patients developed prosthetic valve dysfunction. Nine patients suVered reinfection: four of these (4%) were early and five were late. The median time from surgery for late reinfection was 1.4 years. During follow up, 12 patients died. Excluding operative mortality, actuarial survival was 86.6% at five years and 83.7% at 10 years; actuarial survival free from death, reoperation, and reinfection was 73.1% at five years and 59.8% at 10 years. Conclusions-In patients surviving acute infective endocarditis and receiving mechanical prostheses, the rate of early reinfection compares well with reported results of homografts. In addition, prosthesis dysfunction rate is low and long term survival is good. These data should prove useful for comparison with long term studies, when available, using other types of valve surgery in active infective endocarditis. (Heart 2001;86:63-68) Keywords: infective endocarditis; surgery; mechanical prosthesisThe diagnosis and treatment of infective endocarditis has evolved greatly in recent years. Nevertheless, the morbidity and mortality of this disease remains high.1-4 Initially, medical treatment with an eVective antibiotic is mandatory. If the disease progresses or heart failure symptoms develop because of valve disruption, surgery should be considered. [5][6][7][8][9] Thus the surgical treatment must often be performed in the active phase of the infection. The best timing for the operation and the preferred surgical technique are matters of debate. The most controversial points are the optimal device for the valve replacement and the long term results of such surgery.Our aim in this study was to analyse the long term results of mechanical prostheses for the treatment of active infective endocarditis in our institution during a 22 year period. We report a large prospective series with standardised preoperative management, surgical indications, and long term follow up. Methods PATIENTSAll patients diagnosed with infective endocarditis at our institution between 1975 and 1997 were included in the study. The infectious diseases department supervises all blood cultures taken in our institution on a daily basis in the microbiology laborato...

A Surgical Case of Mitral Regurgitation due to Active Infective Endocarditis with Idiopathic Thrombocytopenic Purpura

“…Congestive heart failure and embolism are the greatest predictive factors of prognosis in patients with infective endocarditis. [5][6][7][8][9][10] This patient was diagnosed as congestive heart failure of NYHA Class IV with vegetation observed both on the anterior and posterior mitral leaflets, both of which exceeded 10 mm, and emergency surgery was indicated although the infection was not controlled. Prognosis of the patient was not expected without surgery although she was also in a high-risk state with cardiac cachexia and thrombocytopenia due to ITP before surgery.…”

Which Valve to Who: Prosthetic Valve Selection for Aortic Valve Surgery

“…Wos and colleagues showed that the risk of recurrent endocarditis was higher with bioprostheses than with mechanical valves (Wos, 1996). Guerra et al also found that the risk of endocarditis reinfection is very low with mechanical valves (Guerra, 2001). Homograft seems to be good choice in severe destructive prosthetic (Musci, 2010) or native (Klieverik, 2009) valve endocarditis with aorto-ventricular dehiscence caused by abscess.…”

Infective endocarditis

“…Contrary to previous reports, there is no evidence that bioprostheses are less susceptible to recurrent infection than metallic valves. 14 The management of cardiac devicerelated IE is a new area and the best outcomes are achieved after close liaison between the cardiologist, cardiac surgeon and microbiologist. The most common pathogens are staphylococci (particularly S. aureus and S. epidermidis).…”