Prosthetic valvular endocarditis: A 12 year review

A retrospective examination was made of a total of 48 patients with infected prosthetic cardiac valves implanted in 1,236 patients. Survival rate of the valvular infections was 40%. The purpose of the study was to determine the factors which aided or decreased patient survival and to develop a program of treatment with antimicrobial agents. Numerous antimicrobics and a variety of dosage schedules were used. Of 19 surviving patients, medical treatment alone was effective in 14, despite the continued presence of a valvular prosthesis. Reoperation was successful in 5 of 9 patients. Lifelong chemoprophylactic or suppressive therapy was shown to be unnecessary to prevent relapse in 12 survivors. Prompt surgical replacement is indicated if antimicrobial therapy fails to eradicate infection of a prosthetic valve. A more systematic approach to antimicrobial therapy should improve survival of medically treated infections. Recommendations are made for prevention and treatment of prosthetic valvular endocarditis.