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

Yu, Victor L.; Fang, Guodong; Keys, Thomas F.; Harris, Angelique; Gentry, Layne O.; Fuchs, Peter; Wagener, Marilyn M.; Wong, Edward S.

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

Cited by 126 publications

(60 citation statements)

References 20 publications

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“…6,24 However, the addition of surgical treatment is thought to improve outcomes, particularly when endocarditis is associated with S. aureus, congestive heart failure, prosthetic dehiscence, valve dysfunction, intracardiac abscess formation, or persistent bacteremia. 25,26 Our patient's incomplete re sponse to intravenous antibiotics, along with the follow up echocardiogram that confirmed the endocarditis and showed pulmonary emboli, prompted our explanta tion of the infected valve.…”

Section: Fig 2 Photograph Shows the Explanted Bioprosthetic Pulmonarmentioning

confidence: 99%

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

O’Brien¹,

Pourmoghadam²,

DeCampli³

2015

Texas Heart Institute Journal

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Section: Fig 2 Photograph Shows the Explanted Bioprosthetic Pulmonarmentioning

confidence: 99%

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

O’Brien¹,

Pourmoghadam²,

DeCampli³

2015

Texas Heart Institute Journal

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“…The overall mortality for PVE has been reportedto be as high as 50%, with early PVE having a higher mortality than late (2,3,7). Whether it carries a poorer outcome than NVE is not clear.…”

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confidence: 98%

“…One caveat is that patients not having surgery may represent patients with greater burden of illness and inherently poorer outcome. This benefit appears most pronounced for patients with S aureus PVE (1,6,7,30), with no difference in surgical versus medical therapy for patients with PVE due to other organisms (6). Relapse of PVE or subsequent cardiac reoperation was more common in patients receiving medical treatment alone (5).…”

mentioning

confidence: 99%

“…Although there is a broad range of potential pathogens, most cases are due to a relatively small number of organisms with some distinction between early and late PVE. Staphylococcus aureus and coagulasenegative are the predominant organisms in early PVE, regardless of a definition of less than two or less than 12 months (1,(4)(5)(6)(7)(8). The predominant organisms in late PVE are, not surprisingly, similar to those causing native valve endocarditis (NVE) with streptococci, enterococci and S aureus most commonly isolated (2,4,5,7,9).…”

mentioning

confidence: 99%

“…Staphylococcus aureus and coagulasenegative are the predominant organisms in early PVE, regardless of a definition of less than two or less than 12 months (1,(4)(5)(6)(7)(8). The predominant organisms in late PVE are, not surprisingly, similar to those causing native valve endocarditis (NVE) with streptococci, enterococci and S aureus most commonly isolated (2,4,5,7,9). Gram-negative bacilli, fungi and fastidious Gramnegative coccobacilli belonging to the Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species (HACEK) group are more unusual causes (10% or less) with Gram-negative bacilli and fungi tending to occur with early PVE, and HACEK organisms with late PVE (4)(5)(6).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Intracardiac Device and Prosthetic Infections: What Do We Know?

Johnston

Conly

2004

Canadian Journal of Infectious Diseases and Medical Microbiolog

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In-Hospital and 1-Year Mortality in Patients Undergoing Early Surgery for Prosthetic Valve Endocarditis

2013

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There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). OBJECTIVE To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. DESIGN, SETTING, AND PARTICIPANTS Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right-or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum. INTERVENTIONS Valve replacement during index hospitalization (early surgery) vs medical therapy. MAIN OUTCOMES AND MEASURES In-hospital and 1-year mortality. RESULTS Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity. CONCLUSIONS AND RELEVANCE Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.

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

Cited by 126 publications

References 20 publications

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

Late Postoperative Prosthetic Pulmonary Valve Endocarditis in a 13-Year-Old Girl with Repaired Tetralogy of Fallot

Intracardiac Device and Prosthetic Infections: What Do We Know?

In-Hospital and 1-Year Mortality in Patients Undergoing Early Surgery for Prosthetic Valve Endocarditis

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