Prosthetic valve endocarditis in southern Spain. Study of 111 cases

Abstract number: p1837

Plata  A., Villalobos  A., Reguera  J.M., Alarcon  A., Galvez  J., Ruiz  J., Lomas  J.M., De la Torre  J., Miralles  F.

Objective: 

To determine the clinical, epidemiological, diagnostic, and therapeutic characteristics of a series of 111 cases of prosthetic valve endocarditis.

Methods: 

We undertook a retrospective, descriptive study of 111 cases of prosthetic valve endocarditis obtained from a series of definite or probable 626 left sided infectious endocarditis from six second- or third-level Andalusian hospitals from 1985 to 2005.

Results: 

Of the 111 cases of prosthetic valve endocarditis, 96 (86.5%) were definite and 15 (13.5%) possible. The mean age was 58 ± 13 years, and they were more common in men (61%). Late infection was more common than early involvement (74 vs. 37 cases). The aortic valve was involved in 54 cases (48%) and the mitral valve in 48 cases (43%. Most (66%) of the valves were made of metal and prior handling had taken place in 26 cases (23%). Clinical characteristics were fever 88%, constitutional syndrome 36%, murmur 41%, vascular events 37%, and immune phenomena 17%. Complications included left ventricular failure 54%, kidney failure 22%, peripheral embolism 20%, CNS embolisms 18% and heart block 9%. The etiology was as follows: in early prosthetic valve endocarditis the three most common pathogens were S. Coagulase-negative (40%), S. aureus (22%) and Enterococcus (11%). Late prosthetic valve endocarditis involved S. viridans (30%), S. Coagulase-negative (17%) and S. aureus (13%). Transesophageal echocardiography alone in 14 cases (12%), and transthoracic followed by transesophageal echocardiography in 53 cases (48%). Medical therapy was applied in 54 cases (48.6%) and surgery in 57 (51.3%). A cure was achieved in 71 cases (64%), the other 40 (36%) dying. Of those who underwent surgery, 38.5% died and 31.4% of those who were treated medically died. The death rate from early prosthetic valve endocarditis was greater than that for late prosthetic valve endocarditis (54% vs. 29%).

Conclusions: 

1) Prosthetic valve endocarditis is a very serious infection which is still associated with an excessively high mortality, despite advances in diagnosis and treatment. 2) Early prosthetic valve endocarditis has a worse prognosis than late prosthetic valve endocarditis, due to its distinguishing pathophysiological features. 3) The greater mortality seen in patients who underwent surgery is probably associated with the fact that they had more complications, such as perivalvular abscesses or persistent infection.