Surgical treatment of prosthetic valve endocarditis.

Despite advances in the diagnosis and treatment of prosthetic valve endocarditis (PVE) it remains a serious complication of prosthetic valve replacement. Antibiotic treatment alone can be successful for late infections that involve the prosthesis only (particularly for patients with bioprothesis), but it rarely cures infections involving the valve-native annulus interface. Combined antibiotic and surgical treatment of PVE often is successful; more accurate diagnosis (usually based on echocardiography), more effective myocardial protection at reoperation, and improved surgical experience have improved the short-term and long-term outcomes for patients with PVE. For 146 patients of Cleveland Clinic Foundation who underwent reoperation for PVE from 1975 through 1992, the overall in-hospital mortality rate was 13%, 10% from 1985 to 1992. In this more recent surgical period, active infection and early PVE did not appear to be factors that increase in-hospital mortality. The mean in-hospital stay of survivors was 25 days, which highlights the fact that even successful treatment of PVE uses enormous resources. The late survival rate of in-hospital survivors was 82% at 5 years, and the reoperation-free survival rate was 75% at 5 postoperative years.