Utility of Transesophageal Echocardiography in the Conservative Management of Prosthetic Valve Endocarditis

Bruss, Jeffrey; Jacobs, Larry E.; Kotler, Morris N.; Ioli, Alfred

doi:10.1378/chest.102.6.1886

Cited by 8 publications

(4 citation statements)

References 9 publications

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“…19 This was confirmed in our study: all our patients with staphylococcal prosthetic valve endocarditis ultimately needed surgery. Conservative management of staphylococcal endocarditis of prosthetic valves therefore does not seem advisable; there appears to be only a single case report of successful conservative treatment, with a follow up of only one year 21. Our conservatively treated patient with coagulase negative staphylococcal endocarditis had a recurrence after 39 months, possibly with the same microorganism despite initial antibiotic treatment for 212 days.…”

Section: Discussionmentioning

confidence: 78%

“…Studies published before 1980 reported mortality rates for early and late prosthetic valve endocarditis of 70% and 45%, respectively 25. More recent studies on the surgical treatment of prosthetic valve endocarditis report an overall in-hospital mortality of approximately 10–25%1 21 25 27 28 and a five year survival ranging from 50% to 75%. The cumulative five year survival rate of 83% in our study group was therefore better than expected.…”

Section: Discussionmentioning

confidence: 99%

“…29 30 Echocardiographic signs of prosthetic valve endocarditis include vegetations on and around the prosthetic valve, valve dysfunction (stenosis, regurgitation, paravalvar leak), and invasion of perivalvar tissue by abscesses and fistulae 8. Early diagnosis of prosthetic valve endocarditis—especially in the presence of negative blood cultures caused by previous use of antibiotics—is thus facilitated by the use of transthoracic, and if this is inconclusive transoesophageal, echocardiography 30.…”

Section: Discussionmentioning

confidence: 99%

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Long term follow up of prosthetic valve endocarditis: what characteristics identify patients who were treated successfully with antibiotics alone?

Truninger

Jost

Seifert

et al. 1999

Heart

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Objective-To identify predictors for the safe use of antibiotic treatment without reoperation in patients with prosthetic valve endocarditis. Setting-Retrospective study in a tertiary care centre. Subjects and design-All 49 episodes of definite prosthetic valve endocarditis (Duke criteria) diagnosed at one institution between 1980 to 1997 were analysed. Ten episodes (20%) were treated with antibiotics only (antibiotic group) and 39 episodes (80%) with combined antibiotic and surgical treatment (surgery group). The analysis included detailed study of hospital records and data on long term follow up which were obtained in all patients by a questionnaire or telephone contact with physician or patient. The length of follow up (mean (SD)) was 41 (32) months in the antibiotic group and 45 (24) months in the surgery group (NS). Long term survival was estimated by the Kaplan-Meier method and compared by the log-rank test. Results-There was no significant diVerence in age, history of previous endocarditis, number of previous heart operations, vegetations, emboli, type of prosthesis, or percentage of early prosthetic valve endocarditis and positive blood cultures between the two groups. In the antibiotic group, there were more enterococcal (50%; p = 0.005) and in the surgery group more staphylococcal infections (55%; p = 0.048). Annular abscesses (p < 0.0001) and aortoventricular dehiscence (p = 0.02) were more common in the surgery group. No patient in the antibiotic group had heart failure. Long term follow up showed no significant diVerence between the surgery and antibiotic groups regarding late mortality (14% v 18%) and five year rates of recurrent endocarditis (14% v 16%), event related mortality (14% v 3%, log-rank test), and the need for reoperation (14% v 19%; log-rank test). The only patient with conservatively treated staphylococcal prosthetic valve endocarditis died after reoperation for recurrence. Conclusions-Haemodynamically stable patients with non-staphylococcal prosthetic valve endocarditis who are carefully supervised can be treated with antibiotics alone without an increased rate of reinfection, reoperation, or death. (Heart 1999;82:714-720)

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long term follow up of prosthetic valve endocarditis: what characteristics identify patients who were treated successfully with antibiotics alone?

Truninger

Jost

Seifert

et al. 1999

Heart

View full text Add to dashboard Cite

show abstract

“…3 Multimodal imaging with echocardiography and computed tomography are integral in determining the extent of cardiac injury in surviving patients, foreign body location, and potential ballistics information. 4 Surgical intervention is typically the cornerstone of management in the hemodynamically unstable patient. 5 We report a case of a suspected acute coronary syndrome (ACS) after a CGSI that was conservatively managed.…”

Section: Introductionmentioning

confidence: 99%