Prosthetic Valve Endocarditis in a Multicenter Registry of Chinese Patients

Abstract

We evaluated the clinical outcomes of prosthetic valve endocarditis in 2 major tertiary referral centers in Hong Kong. The study population comprised 80 consecutive Chinese patients who fulfilled the modified Duke criteria for prosthetic valve endocarditis from March 2000 to June 2007. The major clinical endpoints analyzed were hospital mortality, need for valve surgery, and relapse of prosthetic endocarditis. The mean age at presentation was 56 ± 13 years, with a slight male preponderance. There were 76 (95%) patients with involvement of a mechanical prosthesis; the majority (69%) had late prosthetic endocarditis. Major hospital complications occurred in 49 (61%) patients. The overall hospital mortality was 28% (22 patients). Thirty-four (42%) patients required valve surgery during index hospitalization, of whom 5 (15%) died due to uncontrolled sepsis. Factors associated with hospital mortality were older age at presentation, Staphylococcus aureus infection, embolic events, severe heart failure, valve surgery, and any major complication. On multivariate analysis, severe heart failure was the only independent predictor of hospital death. Among the 58 hospital survivors followed up for a mean of 48 ± 31 months, 6 (10%) developed late complications related to prosthetic valve endocarditis, with 5 documented cases of relapse.

DNA Persistence and Relapses Questions on the Treatment Strategies of Enterococcus Infections of Prosthetic Valves

“…We did not observe any relapses in patients in whom valve replacement was performed during the initial treatment of IE. In our experience, unlike in other reports [23], patients with Staphylococcus aureus –associated prosthetic valve IE who received surgical treatment for the initial episode of endocarditis had a significantly reduced probability of relapse after following our treatment recommendations. These relapses suggest failed therapy.…”

Surgical treatment of late aortic prosthetic valve endocarditis: 19 years’ experience

“…There is a high incidence of postoperative complications in our series. Such results have also been reported by a recent report of PVE from China [ 1 ]. Considering the high rate of preoperative congestive heart failure, these two factors may interact to increase the perioperative mortality in this patient group.…”

“…Prosthetic valve endocarditis (PVE) is a devastating complication of valve surgery. The treatment is usually prolonged medical therapy and surgery in complicated cases [ 1 ]. The incidence is reported to be highest in the early period [ 2 ].…”

Predictors of mortality in patients with prosthetic valve infective endocarditis: A nation-wide multicenter study

“…For patients with PVE the best treatment strategy is still controversial because guidelines based on prospective randomized trials are lacking [4,16,17]. Numerous studies indicate that the prognosis of patients with PVE is better using a combined medical-surgical approach than when antibiotic treatment alone is used [15,18].…”

“…Prosthetic valve endocarditis (PVE) remains a diagnostic challenge, with non-specific and variable clinical symptoms and cardiac conditions. Treatment options include prolonged antibiotic therapy, repair of prosthetic valve and repeat valve replacement in complicated cases [3][4][5][6]. PVE not only carries a high in-hospital mortality risk but also is associated with high long term mortality and needs close follow up.…”